HIV or HBV Co-infected

CO-INFECTION (infection with at least 2 of HCV, HBV, and/or HIV)
Co-infection is when a person is living with more than one infection at a time.

Human immunodeficiency virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) co-infection has emerged as a leading cause of morbidity due to liver disease throughout the world over the last two decades.

Transmission Mode and Prevention of Co-infection

  • Among HIV-infected patients, HBV and/or HCV co-infections are more prevalent due to overlapping transmission routes.
  • As a consequence, there has been increasing focus on diagnosis of HBV and HCV in the management of HIV-infected patients.
  • Hepatitis C co-infection has increasingly been reported in HIV-positive men having sex with men (MSM) who have NOT used injection drugs, so this is an additional risk for men.
  • Although the risk of hepatitis C transmission sexually is very low in monogamous heterosexual relationships, it is not absent. Studies show that having multiple sex partners or engaging in rough sex, and being infected with HIV or another sexually-transmitted infection (STI) may increase the risk of hepatitis C infection even among heterosexual couples.
  • The GOOD NEWS is that prevention education and harm-reduction methods/supplies for all three diseases are overlapping as well. In general, successfully preventing one will prevent them all.

Effects of Co-infection

  • In co-infection, the presence of one virus affects the action of the other virus. HIV accelerates the natural course of HBV and HCV infection and facilitates faster progression of liver disease to cirrhosis and liver cancer (HCC).
  • Disease progression to cirrhosis in HIV positive patients is almost three-times faster as compared to HBV or HCV patients without HIV.
  • Overall survival of HIV positive patients is not affected by the presence of HCV.
  • However, patients co-infected with HIV and HCV have greater risk of dying from liver failure compared to patients who have only HIV.

Facts at a glance

  • Internationally, the prevalence of HBV co-infection among people with HIV varies from 5%-20%, depending on whether HBV is endemic in the geographic area; likewise, the prevalence of HCV co-infection varies from 9-16 % depending on geographic area.
  • In Canada, it is estimated that a large proportion (18%) of people with HIV are co-infected with HCV.
  • The strongest predictor or risk factor of co-infection is a history of intravenous drug use (IDU), with co-infection rates estimated to range from 50–92% among HIV+ members of IDU populations. As a result, the populations affected most severely by co-infection are those in which IDU is most prevalent, such as among current and former prisoners and aboriginal populations.
  • Two separate studies in Ontario and Québec prisons found that the prevalence of hepatitis C among HIV-positive inmates was 68% and 65% respectively.
  • Although antiretroviral (ARV) therapy has significantly extended the life expectancy of persons with HIV infection, liver disease—much of which is related to hepatitis C and B infection—has become the leading cause of non-AIDS-related deaths among this population.
  • While we applaud the development of “U=U” (UNdetectable for HIV = UNtransmittable for HIV) due to highly effective ARVs, we note that the danger of HCV or HBV transmission remains.
  • Get vaccinated for HBV and HAV! Use harm reduction during IDU and sex! Get tested regularly!


  • If you are living with HIV and Hepatitis C coinfection, check out this page from CATIE
  • If you are living with HIV and Hepatitis C coinfection, check out this page from the Hepatitis B Foundation

Some excellent videos about HIV or HBV co-infection along with HCV:

First, the incredible story of a Jules Levin, a man co-infected with HIV and HCV.  He is also the founder of NATAP (National AIDS Treatment Advisory Project).

Next, almost an hour of video about HIV/HCV coinfection from Duke University from the doctor’s point of view. Late 2010, very interesting!