HIV/hepatitis coinfection

Infection in people who inject drugs (PWID) or men who have sex with men (MSM) drives HIV epidemics in many countries in the WHO European Region. These populations also report a high prevalence of co-infection with hepatitis B or C due to the same modes of transmission – unprotected sexual intercourse and sharing of injecting equipment.

HIV accelerates the course of liver disease associated with hepatitis C virus (HCV), particularly in patients who are more severely immune deficient.

  • Patients co-infected with HCV/HIV have a more rapid fibrosis progression than HCV mono-infected patients. They are also more likely to have quantitative and/or qualitative deficiencies in their immune responses to HCV, resulting in a significant decrease in spontaneous clearance.
  • The risk of mother-to-child and sexual transmission increases on average from 6% to 20% and from 0% to 3%, respectively in patients co-infected with HCV/HIV.
  • Liver failure in HIV/HCV co-infected patients is one of several top causes of death.

HIV accelerates hepatitis B virus (HBV) disease progression.

  • HBV infection is more severe in people co-infected with HIV.
  • Higher HBV replication results in more severe liver fibrosis with increased risk (4.2 times greater) for cirrhosis and a faster progression to end-stage liver disease.
  • In HIV/HBV co-infected patients with cirrhosis, hepatocellular carcinoma (HCC) may appear more aggressive and at earlier age.
  • HIV appears to be a risk factor for reactivation of hepatitis B in patients who have developed hepatitis B surface antibody (HBsAb).
  • Co-infected patients have an increased risk of liver-related mortality.

New WHO guidelines on antiretroviral therapy for HIV include recommendations on management of patients co-infected with hepatitis B.