Hepatitis Co-Infection in People With HIV

Hepatitis is the inflammation of the liver. The inflammation can be caused by many different things, including medications, viruses, exposure to chemicals, environmental toxins, autoimmune disorders, and alcohol use.

Within the context of HIV, there exists a high rate of co-infection with certain types of viral hepatitis, most specifically hepatitis C (HCV). In fact, epidemiological research suggests that as many as 30% of Americans with HIV may also be infected with HCV.

Given these statistics, it is important to understand the signs and symptoms of viral hepatitis, as well as the types of viruses that cause the disease.

Illustration of Hepatitis C particals

Stages of Hepatitis Infection

Viral hepatitis can be broadly classified by stage of infection.

Acute Infection

Acute infection typically occurs at or near the time of exposure to the virus. The onset of symptoms can be sudden or gradual, but are most often short-lived, usually resolving within the span of two months.

During this stage, liver damage is usually mild as evidenced by scarring (fibrosis) on the liver itself. Liver function is generally unimpeded, and the symptoms, if any, are rarely fatal. In some cases, an acute infection may spontaneously clear, leaving no evidence of virus or damage.

Chronic Infection

Chronic infection is that which persists over a long period of time. Symptoms in the early part of the chronic stage may be non-specific to nonexistent despite the fact that fibrosis may be advancing in the liver.

During this stage, the infection can be described as either chronic persistent (with symptoms developing slowly and mildly) or chronic acute (when the symptoms are more serious).

Among those with untreated chronic hepatitis, there is an increased risk of cirrhosis, a condition in which the scarring of the liver is so extensive that it interferes with the function of the liver (compensated cirrhosis) or stops it altogether (decompensated cirrhosis).

Other later-stage manifestations of chronic infection include hepatocellular carcinoma, a life-threatening form of liver cancer that may require a liver transplant.

Signs and Symptoms

Signs and symptoms of hepatitis can vary, and the majority of cases may not present with any symptoms at all. In fact, many infections will resolve without the person even knowing that an infection had taken place.

Acute Infection

Among those who do have symptoms, the most common signs of acute infection include:

  • Jaundice (yellowing of the eyes and skin)
  • Choluria (darkening of the urine)
  • Fever
  • Fatigue
  • Nausea
  • Vomiting
  • Abdominal pain
  • Joint pain (arthralgia)
  • Muscle pain (myalgia)

Chronic Infection

During the chronic stage of infection, symptoms can become more pronounced, although rarely incapacitating. In many cases, they are difficult to ascribe to liver dysfunction alone.

Common signs of chronic infection include:

  • Abnormal tingling or burning sensations (paresthesia)
  • An uncomfortable “pins-and-needles” sensation (peripheral neuropathy)
  • Itchy skin (pruritus)
  • Raised, bumpy areas of rash (urticaria)
  • Dry eyes accompanied by dry mouth (Sicca syndrome)

It is only when the liver is cirrhotic and its function is impaired that the symptoms become more indicative of liver disease.

Signs and symptoms of compensated cirrhosis include:

  • Spider veins (spider nevi), mainly on the trunk and face
  • Itchy skin (pruritus)
  • Redness on the palms of the hands (palmar erythema)
  • Easy bruising or abnormal bleeding (variceal bleeding)
  • The buildup of fluid in the ankles and feet (edema)
  • Poor concentration and memory
  • Loss of appetite (anorexia)
  • Weight loss
  • Shrinking testicles (testicular atrophy)
  • Erectile dysfunction or loss of libido
  • Alcohol intolerance

Decompensated cirrhosis and hepatocellular carcinoma are both classified as end-stage liver diseases.

Types of Viral Hepatitis

Currently, seven viruses are associated with hepatitis infection, designated by the letters A through G. Their modes of transmission, geographic distribution, and presentation can vary, as well as the options available to either prevent or treat an infection.

The seven viral types are:

  • Hepatitis A (HAV), formally known as infectious hepatitis, is always acute and never becomes chronic. HAV is transmitted by contact with infected feces or fecal-contaminated food or water. HAV infection is often a result of poor handwashing practices among food handlers. A hepatitis A vaccine is available to prevent infection, delivered in a series of injections.
  • Hepatitis B (HBV), formally known as serum hepatitis, is transmitted via sexual contact, saliva, shared contaminated needles, and exposure to infected blood. HBV often will progress to chronic hepatitis without showing signs of active hepatitis. The risk of contracting hep B can be reduced with a hepatitis B vaccine, while the Twinrix vaccine can offer protection from both HAV and HBV.
  • Hepatitis C (HCV) is transmitted primarily by the shared use of contaminated syringes and needles, but can also be passed from mother to child during pregnancy and, less commonly, through sexual contact. HCV can spontaneously clear from as many as 40% of infected individuals without any sign of symptoms. Others will progress to a chronic infection that can go undetected for years. While there is no vaccine to prevent hepatitis C, powerful direct-acting antivirals (DAAs) can deliver cure rates of up to 99% in some populations. The CDC recommends that all people born between 1945 and 1965 be tested for hepatitis C.
  • Hepatitis D (HDV) is a form of viral hepatitis that can only be replicated by attaching to an HBV. As such, it can accompany an HBV infection but not manifest on its own.
  • Hepatitis E (HEV) is similar to HAV and is similarly transmitted through contaminated food and water or contact with infected feces. Once thought to be rare, increased international travel has led some experts to estimate that up to 20% of Americans could be infected.
  • Hepatitis F (HFV) is a theoretic virus that some believe may cause hepatitis. Despite a number of potential infections in the 1990s, there has yet to be substantiation of the virus’s existence.
  • Hepatitis G (HGV) is most often present in combination with hepatitis A, B, or C.

A Word From Verywell

Of the seven viral types, hepatitis B and hepatitis C both pose serious risks to people with HIV, complicating what is already a serious infection. Fortunately, in recent years there have been major advances in treatments that can vastly slow the rate of damage to the liver or eradicate the viral infection altogether.

This is especially true with hepatitis C, in which drugs like Harvoni and Mavyret offer cure rates of as much as 99% in people co-infected with HIV.

To this end, it is important to discuss viral hepatitis screenings with your healthcare provider and available treatment options if you test positive for hepatitis B or C.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.