World AIDS Day - Coinfection with HIV and Viral Hepatitis

An estimated 1.2 million persons are living with HIV in the United States. Of people living with HIV in the United States, about 25 percent are coinfected with hepatitis C virus (HCV), and about 10 percent are coinfected with hepatitis B virus (HBV). People living with HIV infection are disproportionately affected by viral hepatitis, and those who are coinfected are at increased risk for serious, life-threatening complications. HIV coinfection more than triples the risk for liver disease, liver failure, and liver-related death from HCV. Because viral hepatitis infection is often serious in people living with HIV and may lead to liver damage more quickly, CDC recommends all persons at risk for HIV be vaccinated against hepatitis B and be tested for HBV and HCV infection. December 1st has been designated World AIDS Day, creating an opportunity not only for raising awareness about HIV infection, but educating health professionals and the general public worldwide about the overwhelming burden of HIV and viral hepatitis coinfection, and the importance of testing, care, and treatment.

Transmission
Hepatitis B virus, hepatitis C virus, and HIV are bloodborne viruses that can spread when blood from a person infected with the virus enters the body of someone who is not infected. These viruses are spread through sexual contact, exposures to blood in health care settings, and behaviors associated with injection drug use. Because of these shared modes of transmission, persons living with or at risk for HIV are also at substantial risk for HBV and HCV infection.

Hepatitis B: An estimated 1.2 million persons in the United States are living with hepatitis B.  When compared with HIV, the hepatitis B virus is 50–100 times more infectious than HIV and is most commonly spread through sexual contact.  

Hepatitis C: An estimated 3.2 million persons in the United States are living with hepatitis C. The hepatitis C virus is approximately 10 times more infectious than HIV and lives longer outside of the body. A large number of persons, including those living with HIV, were infected many years ago before the virus was discovered in 1989. This population of baby boomer (i.e., persons born during 1945-1965) are now at immediate risk for life threatening liver damage and cancer caused by HCV. Gay, bisexual, and other men who have sex with men living with HIV are at particular risk for sexual transmission of HCV, and persons who inject drugs (PWID) who share needles, syringes, or any other drug-injection equipment represent a growing number of new infections. As a result of the expanding epidemic of injection opioid use in primarily non-urban America, PWID living in these areas are increasingly at risk for HIV-HCV coinfection, as evidenced by the recent outbreak of HIV in Scott County, Indiana.  As of November 6th, a total of 181 persons were found to be infected with HIV in Scott County, more than 90% of whom were already infected with HCV.  High rates of HCV in a community can serve as an early warning signal of increased drug use and transmission of other blood borne viruses, including HIV.

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