Epidemiology and Prevention of HIV and Viral Hepatitis Co-infections

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Hepatitis B

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are bloodborne viruses transmitted primarily through sexual contact and injection-drug use. Because of these shared modes of transmission, a high proportion of adults at risk for HIV infection are also at risk for HBV infection. HIV-positive persons who become infected with HBV are at increased risk for developing chronic HBV infection [1]. Persons who are coinfected with HIV and HBV can also have serious medical complications and are at increased risk for liver-related morbidity and mortality [2-4]. To prevent HBV infection in HIV-infected persons, the Advisory Committee on Immunization Practices (ACIP) recommends universal hepatitis B vaccination for all susceptible persons infected with HIV [5]. The first vaccine dose may be administered immediately after collection of blood for prevaccination serologic testing [5], and regardless of CD4+ lymphocyte cell count [6]. To confirm adequate immune response, post-vaccination serologic testing for protective concentrations of antibodies to hepatitis B surface antigen should be conducted 1–2 months after completion of the hepatitis B vaccine series [5].

Hepatitis C

In 2009, approximately 21% of HIV-infected adults who were tested for past or present HCV infection tested positive, although coinfection prevalence varies substantially according to HIV-infected risk group (e.g., men who have sex with men [MSM], high-risk heterosexuals, and persons who inject drugs) [7-9]. As HCV is a bloodborne virus transmitted through direct contact with the blood of an infected person, coinfection with HIV and HCV is common (62–80%) among HIV-infected injection-drug users [8-10]. Although transmission via injection drug use remains the most common mode of HCV acquisition in the United States [10], sexual transmission is an important mode of acquisition among HIV-infected MSM with risk factors, including those who participate in unprotected anal intercourse, use sex toys, and use non-injection drugs [6]. HCV is one of the primary causes of chronic liver disease in the United States, and HCV-related liver injury progresses more rapidly among persons coinfected with HIV [11-15]. HCV infection may also effect the management of HIV infection [6, 15, 16]. Guidelines recommend that all HIV-infected persons be screened for HCV infection and that persons with increased risk be retested annually [6, 1516].

Guidelines and Recommendations

Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices
MMWR 2018; 67 (RR 1);1–31

Sexually Transmitted Diseases Treatment Guidelines 2015
MMWR 2015;64(No.3)

Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection
MMWR 2008;57(RR-8)

Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease
MMWR 1998;47(RR-19)






1. Gatanaga  H, Yasuoka  A, Kikuchi  Y, et al. Influence of prior HIV-1 infection on the development of chronic hepatitis B infection. Eur J Clin Microbiol Infect Dis. 2000 Mar;19(3):237-9.

2. Thio  CL, Seaberg  EC, Skolasky  R, et al. Multicenter AIDS Cohort Study. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet. 2002 Dec;360(9349):1921-6.

3. Bonacini M, Louie S, Bzowej N, et al. Survival in patients with HIV infection and viral hepatitis B or C: a cohort study. AIDS. 2004 Oct 21;18(15):2039-45.

4. Weber  R, Sabin  CA, Friis-Møller  N, et al. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006 Aug 14-28;166(15):1632-41.

5. Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR 2018;67(1):1-31.

6. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf Cdc-pdf[PDF – 435 pages]External. Accessed July 6, 2018.

7. Garg S, Brooks J, Luo Q, Skarbinski J. Prevalence of and Factors Associated with Hepatitis C Virus (HCV) Testing and Infection Among HIV-infected Adults Receiving Medical Care in the United States. Infectious Disease Society of America (IDSA). Philadelphia, PA, 2014.

8. Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, Berry SA, et al. Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts. PLoS ONE 2014;9(7):e102766. https://doi.org/10.1371/journal.pone.0102766External.

9. Spradling PR, Richardson JT, Buchacz K. Trends in hepatitis C virus infection among patients in the HIV Outpatient Study, 1996–2007. J Acquir Immune Defic Syndr 2010;53:388–396.

10. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2015 Cdc-pdf[PDF – 75 pages]. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2017.

11. Telfer P, Sabin C, Devereux H, et al. The progression of HCV-associated liver disease in a cohort of haemophilic patients. Br J Haematol. 1994;87(3):555–561.

12. Soto B, Sanchez-Quijano A, Rodrigo L, et al. Human immunodeficiency virus infection modifies the natural history of chronic parenterally-acquired hepatitis C with an unusually rapid progression to cirrhosis. J Hepatol. 1997;26(1):1–5.

13. Benhamou Y, Bochet M, Di Martino V, et al. Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The Multivirc Group. Hepatology. 1999;30(4):1054–1058.

14. Graham CS, Baden LR, Yu E, et al. Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis. 2001;33(4):562–569.

15. AIDSinfo. Fact sheet. HIV and hepatitis C.  https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/26/88/hiv-and-hepatitis-cExternal. Accessed July 6, 2018.

16. American Association for the Study of Liver Disease/Infectious Diseases Society of America. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Available at https://www.hcvguidelines.org/External. Accessed July 6, 2018.