HIV and hepatitis coinfection

It is estimated that about 5% of people with HIV in Australia have chronic hepatitis B.

Hepatitis B can have no symptoms for a long time.  Symptoms can be vague and include flu-like chills and fevers, joint and muscle pain, fatigue, loss of appetite, stomach pain, nausea/ vomiting and jaundice.

In Australia, as well as globally, most people with chronic hepatitis B got it when they were born because one or both of their parents had it too. Babies and children who get hepatitis B usually develop chronic infection. However older children and adults who get hepatitis B usually fight off the infection and develop life-long immunity.

For people with HIV and hepatitis B it’s a bit different. Some will have got it at birth, but most will have developed chronic hepatitis B because they got it after they had already been living with HIV.  This is because their bodies were less able to fight off the acute (short-term) infection.

PLHIV can be successfully vaccinated against hepatitis B. In some cases, a longer course of vaccinations might be needed.

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Hepatitis B transmission and prevention 

Hepatitis B is a type of Sexually Transmissible Infection (STI) and is passed on through blood, semen and vaginal fluids. It can also be transmitted during childbirth, as well as through unsterile injecting.

Hepatitis B prevention

• Vaccination is free for all people with HIV and their partners and housemates  – ask your GP!
• Condoms and water-based lubricant prevent hepatitis B being passed on during sex
• Use sterile injecting equipment and safer injecting practices every time
• Make sure your tattooist or piercer follows correct infection control precautions
• Don’t share toothbrushes, razors or any personal items that might have blood on them

Hepatitis B testing 

Hepatitis B testing might be included in your regular STI checkup, but you can check with your doctor to see if you’ve been tested or have immunity.
Testing can tell you if you have hepatitis B, and if you don’t have hepatitis B the test can show whether you are immune from either a vaccine or a past infection.

Hepatitis B treatment

Regular monitoring blood tests are really important for anyone with chronic hepatitis B, and this is the same for people with HIV and hepatitis B.

Anyone with HIV who also has chronic hepatitis B should be treated for both conditions.
The goal of hepatitis B treatment is viral suppression, and the good news is that there are antivirals that are highly effective against both HIV and chronic hepatitis B, which means fewer pills and side effects.

People with HIV and hepatitis B can access their care through a hospital ID clinic or a specialist (S100) GP doctor.

In 2016, about 10% of people with HIV in Australia also had chronic hepatitis C.  Since then, new treatments that can cure hepatitis C have significantly reduced the number of people living with both HIV and hepatitis C.

Hepatitis C acts slowly.  Left untreated, hepatitis C can cause major liver damage and cancer, but it usually takes several decades.  Most people don’t have any symptoms until they have liver damage.

Symptoms can be vague and include flu-like chills, fevers and pain, fatigue and trouble sleeping, loss of appetite, stomach pain and nausea, anxiety and depression.

Having HIV makes hepatitis C act more quickly and does more damage to the liver.  This is why it is recommended that people start hepatitis C treatment to try and clear (cure) their hepatitis C.

The effect of hepatitis C on HIV progression is less certain.  Most studies have found that hepatitis C does not impact HIV disease progression, however there are some studies that suggest that it might.

There is no vaccine against hepatitis C because there is no immunity against hepatitis C.  That means that people who have had hepatitis C and been cured by the treatment could get hepatitis C again.

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Hepatitis C transmission and prevention

Hepatitis C is transmitted when blood containing the hepatitis C virus enters the bloodstream of another person. Hepatitis C is mainly passed on through unsterile injecting and can also be passed on during childbirth or unsterile tattooing/ body piercing.

Hepatitis C is not an STI, but there is a small chance that hepatitis C can be passed on during sex if blood is present.  This is more common during anal sex.  This means that men who have sex with men are at higher risk of getting and passing on hepatitis C during sex.

For people with HIV, especially men who have sex with men, there is an even greater chance that hepatitis C can be passed on sexually.

Hepatitis C prevention 

• Use sterile injecting equipment and safer injecting practices every time
• Using condoms and gloves for anal play can prevent hepatitis C
• Make sure your tattooist or piercer follows correct infection control precautions

Hepatitis C testing 

A hepatitis C test is recommended for all people with HIV.  Hepatitis C testing is not usually included in an STI checkup – ask your doctor.

Annual hepatitis C testing is recommended for PLHIV who inject and also HIV-positive men who have sex with men.

Testing can tell you if you have a current hepatitis C infection, and it will also show if you have had an infection in the past and cleared it naturally (which happens sometimes).

Hepatitis C treatment and cure 

Hepatitis C treatments can cure hepatitis C. Even better, the chance of being cured after hepatitis C treatment is similar for people with HIV as for the general population.  The chance of being cured mostly depends on how much liver damage a person has.

The treatment for hepatitis C is usually a course of antivirals pills that are taken for 2 to 6 months.  Early treatment is recommended for people who have HIV to reduce the amount of liver damage.  You can be treated for hepatitis C while you are taking HIV medications, but your doctor will need to make sure your current HIV regimen won’t be affected by the hepatitis C antivirals.  There can be side effects from the hepatitis C antivirals but they are nothing like they used to be!  Most people only have to take them for 2-3 months.