CDC guidance for health care providers.
Key points
- People with HIV and existing liver disease risk severe illness from hepatitis A (HAV).
- People with HIV who get hepatitis B (HBV) or C (HCV) face higher risk of liver disease and death.
- HBV or HCV can complicate HIV treatment.
- People with HIV should be vaccinated against hepatitis A and B and tested for B and C.
The risks
| Virus | What's different with HIV |
|---|---|
| Hepatitis A | severe disease if the liver is already damaged; the vaccine may not give long-term protection |
| Hepatitis B | spread like HIV — through sex and shared injection equipment — so many adults at risk for one are at risk for both; more liver disease and death |
| Hepatitis C | spread by contact with infected blood. In 2009, about 21% of adults with HIV who were tested had current or past HCV — 62%–80% among people with HIV who inject drugs. Sharing injection equipment is the commonest route, but sexual spread happens among men who have sex with men. HCV is a leading cause of chronic liver disease, and liver damage progresses faster with HIV |
Hepatitis A: vaccinate, then check
Since 2020, CDC and the Advisory Committee on Immunization Practices (ACIP) recommend that everyone with HIV aged 1 year or older:
- be vaccinated against hepatitis A;
- get post-vaccination serologic testing (PVST) 1–2 months after the series.
Tell patients that, whatever the result, protection may not last, and they may need immune globulin after a high-risk exposure (sexual or household contact). More: vaccinating against hepatitis A.
Hepatitis B: screen, test, vaccinate, treat
- Screen everyone 18 and older at least once, with three tests: HBsAg, anti-HBs and anti-HBc.
- Test anyone susceptible with ongoing risk, at any age — including people with HIV, a history of STIs or multiple partners, and those who share injection equipment — and periodically while the risk lasts. Test anyone who asks, whether or not they disclose a risk.
- Test everyone with hepatitis B for HIV.
- Don't let testing delay vaccination: where testing isn't feasible, vaccinate anyway.
- ACIP recommends HBV vaccine for all infants from birth, all adults 19–59, and adults 60 and older with risk factors such as HIV — with PVST for people with HIV 1–2 months after the series.
- The HHS panel's HIV guidelines cover revaccinating non-responders.
- Treatment: for people with both, use HIV medicines that also act against HBV.
More: hepatitis B testing and vaccination.
Hepatitis C: test and treat
- Test all adults 18 and older once, and pregnant patients in every pregnancy.
- Test periodically people with risk factors, such as HIV or shared injection equipment.
- Treat promptly: the AASLD and IDSA recommend timely direct-acting antivirals for people with both HIV and HCV. More: HCV clinical care.
Guidelines
- Prevention of Hepatitis A Virus Infection in the United States (ACIP, 2020)
- Screening and Testing for Hepatitis B Virus Infection (CDC, 2023)
- Universal Hepatitis B Vaccination in Adults Aged 19–59 Years (ACIP, 2022)
- Prevention of Hepatitis B Virus Infection in the United States (ACIP)
- Identification and Public Health Management of Persons with Chronic HBV Infection
- CDC Recommendations for Hepatitis C Screening Among Adults (2020)
- Prevention and Control of HCV Infection and HCV-Related Chronic Disease
- Sexually Transmitted Diseases Treatment Guidelines, 2015
Also: CDC's HIV and STD pages, and NIH HIVinfo.
Sources
Based on "Viral Hepatitis Among People with HIV," Centers for Disease Control and Prevention; a work of the United States government in the public domain. The page's stock photograph is not reproduced. Its text gives PVST for hepatitis A both as "1 month or more" and "1–2 months" after the series.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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