Human Immunodeficiency Virus (HIV) and Hepatitis B and C coinfections: is there a cure?

Hepatitis B (HBV) and C (HCV) are different, but they share the same target: the liver. The liver is the body’s largest internal organ that performs many metabolic functions, including detoxification. HBV and HCV are viral infections that cause inflammation and infection of the liver threatening the liver’s ability to function. Because these infections can spread in a similar way to the human immunodeficiency virus (HIV), people with HIV are at higher risk for chronic viral hepatitis. Coinfection of HIV with HBV and HCV are major public health problems worldwide. Sad to say, viral hepatitis progresses faster and causes more liver damage among people with HIV than among those who do not have HIV. This is one of the reasons by which HBV- and HCV-related liver disease is the main cause of non-AIDS-related deaths among people with HIV. Given the risks of HBV or HCV coinfection for people living with HIV, it is vital to understand the risks encountered, how to prevent the disease from occurring, and, if necessary, get the most appropriate treatment for the disease. 

Prevalence and transmission of HIV and hepatitis coinfections 

HBV and HIV are bloodborne viruses transmitted mainly through sexual contact and needle sharing for drug use. Due to these similar modes of transmission, people at risk for HIV infection are also at risk for HBV infection. In addition, HCV is also a bloodborne virus and is mainly transmitted through direct contact with the blood of an infected person. New estimates suggest that HCV and HBV affect around 2-15% and 5-20% of people living with HIV, respectively.  Of concern, the World Health Organisation (WHO) has estimated that the global burden of HIV-HCV and HIV-HBV coinfections are 2.75 million and 2.6 million, respectively.  

Is hepatitis testing recommended for people living with HIV?

Yes. It is recommended that everyone living with HIV gets tested for HBV and HCV following their first HIV diagnosis and prior to starting the treatment. The Centers for Disease Control and Prevention (CDC) have set new recommendations that enforce the need for testing, especially for all adults 18 years and older (one-time screening), all pregnant women during every pregnancy, and all people with risk factors. 

How can hepatitis B (HBV) and C (HCV) be prevented? 

The best way to prevent HBV from being transmitted is through vaccination. People living with HIV who do not manifest active HBV infection should be vaccinated against it. This is not feasible however for HCV because no vaccination exists yet. For this reason, the best way to prevent HCV is to never inject drugs or stop injecting drugs by seeking drug rehabilitation treatment. 

What is the treatment for HIV-HBV/HCV co infections? 

Fortunately, HIV-HBV and HIV-HCV co infections can be effectively treated in most people nowadays. It goes without saying that medical treatment is complex and should be administered by healthcare providers whose expertise is in the management of both HIV infections and viral hepatitis. Treatment for HBV can delay or, more importantly, limit liver damage by suppressing the virus that attacks the immune system. Similar to HIV treatment, HBV treatment, in most cases, needs to be taken indefinitely. Regarding HCV, even though no vaccination exists, this disease is curable. But, if left untreated, it causes liver damage - known as liver cirrhosis, liver cancer, and even death. As science and medicine are moving forward, ongoing research is being conducted that could lead to a vaccine that effectively prevents HCV. In the meantime, new treatments for HCV have been recently approved and include ledipasvir-sofosbuvir (Harvoni), ombitasvir-paritaprevir-ritonavir (Technivie), ombitasvir-paritaprevir-ritonavir and dasabuvir (Viekira Pak), daclatasvir-sofosbuvir (Darvoni or Sovodak), glecaprevir-pibrentasvir (Mavyret), sofosbuvir-velpatasvir (Epclusa), and sofosbuvir-velpatasvir-voxilapresvir (Vosevi). These direct-acting antiviral treatments are more efficacious than previously available treatments since they have fewer side effects and do not require an injection. Most strikingly, they cure about 97% of people with HCV with just 8-12 weeks of treatment consisting of oral administered pills. 

The take-home message 

Even though there are treatments available for HIV and hepatitis coinfections, the best option is to take steps to help prevent becoming infected. Alternatively, if you are at risk of being exposed to HBV, your best bet is to get the HBV vaccine. Similarly, if you are at risk of being exposed to HCV, it is recommended that you get regular HCV screenings. This is because if you get HCV, the sooner you know, the better your chances are for successful treatments(s) and survival.