Hepatitis B and HIV Co-infection



Hepatitis B-HIV co-infection occurs when someone is infected with both hepatitis B virus and Human Immunodeficiency Virus, either simultaneously or in separate incidents.  Infection with both viruses results in a more rapid progression of liver damage, and an increased risk of both liver failure and liver cancer.

What is hepatitis B?

Hepatitis B is a liver disease caused by infection with the hepatitis B virus (HBV). The virus causes inflammation of the liver, which over time leads to scarring of the liver tissue that can prevent the liver from functioning.   Liver failure and liver cancer are long-term risks of hepatitis B infection.


What is HIV?

HIV stands for human immunodeficiency virus. HIV attacks the body’s immune system, which protects the body by fighting off infection from viruses and bacteria. If not treated, someone with HIV may develop acquired immunodeficiency syndrome (AIDS), at which point the immune system becomes very weak and unable to fight off infection.


How is hepatitis B transmitted?

Hepatitis B is transmitted when infectious blood and sexual fluids enter the bloodstream though a break in the skin or via a mucus membrane. Having unprotected sex is one of the most common risk factors, with the risk of sexual transmission increasing with multiple sex partners. Sharing needles, straws, and drug paraphernalia while injecting drugs, traveling to an endemic country where the HBV prevalence is high, and receiving body art in an unsafe setting are additional risk factors.  Children born to hepatitis B-positive mothers can become infected during labor if preventative steps aren’t taken.  Healthcare workers exposed to accidental needle sticks, and long-term hemodialysis patients may be at risk.  Sharing personal items that come into contact with blood (toothbrushes, nail clippers, etc.) can also transmit the virus


How is HIV transmitted?

HIV is also transmitted through blood and sexual fluids, as well as breast milk.  Primary risk factors include having unprotected sex and/or sharing needles with someone who has HIV. Mother-to-child transmission can occur during pregnancy, birth, or breastfeeding.  Accidental needle sticks with HIV-contaminated needles are a risk mainly for health care workers. 


What are symptoms of HBV and HIV?

• HBV symptoms- Less than 40% of individuals report flu -like symptoms in their first month of being infected. Symptoms may not reappear until the virus has caused significant liver damage, and may include jaundice, clay-colored bowel movements, abdominal pain, and fatigue.

• HIV symptoms- Some individuals may experience flu-like symptoms within the first 2-4 weeks of infection, including fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. Other, more severe symptoms may occur if an HIV infection progresses towards AIDS.


What are treatment options for HIV-HBV co-infected individuals?

In the United States, about 5-10% of HIV patients are co-infected with HBV. Treatment options are available for both HIV and HBV. While there is no cure for hepatitis B nor HIV, current treatments can lower viral load and minimize damage to the liver and immune system. Usually HIV treatment is prescribed first to strengthen the immune system so that HBV treatment can be more effective. Consulting with a specialist to explore your options based on lifestyle, commitment, and other factors are recommended before getting treatment. 

Eating healthy, exercising, and reducing the consumption of alcohol and/or drugs can help reduce the progression of HBV and HIV. Enrolling in a support group can help cope with any mental and emotional stress. 


What are the statistics? 

Worldwide, 3-6 million people have a coinfection of HBV and HIV.

What are ways to protect against HIV and HBV?

To protect against HIV and HBV, practice safe sex by using condoms when engaging in sexual activities, know your status and the status of your partner, and reduce the number of sexual partners. If you or your partner has HIV taking pre-exposure prophylaxis (PrEP) helps reduce the chance of getting HIV.  Other ways to protect against HIV and HBV include not sharing needles or any drug-use equipment, and not sharing any personal items that may come into contact with blood or sexual fluids. It is also recommended to avoid getting tattoos at unlicensed location, to clean up spills with a 10:1 bleach solution, to wash hands after cleaning up blood, and dispose of any contaminated items properly. 


Where can I get tested for HIV and HBV?

Colorado has multiple locations that offer free HIV testing and provide risk reduction counseling to reduce your risk of infection, as well education around preventing infection. For a current list of HIV testing sites visit www.liverhealthconnection.org.  If you believe you have been exposed to HBV, consulting a primary physician on running a 3-part HBV panel is recommended. 


Where can I get more Information?


Liver Health connection: 1-800-522-4372 or visit the website at www.liverhealthconnection.org. Liver health connection provides information, support, and resources for people with HBV and HIV Co-infection.


Colorado Department of Public Health and Environment’s Viral Hepatitis Program: (303) 692-2780. Visit their site at www.HepaititsColorado.info.


Center for Disease Control and Prevention hepatitis web site at www.cdc.gov/hepatitis.   

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World Hepatitis Alliance Member