Hepatitis & HIV: Understanding the Connection This Awareness Month

May Is National Hepatitis Awareness Month

Every May, health advocates across the country observe National Hepatitis Awareness Month — a time to shine a light on viral hepatitis, one of the most underdiagnosed and undertreated conditions in the United States. This year, Project Health Outreach is using this observance to highlight a critical but often overlooked connection: the intersection of hepatitis and HIV.

For the communities we serve in Pasco, Pinellas, and Hillsborough Counties, this connection is not academic. It is a daily reality for thousands of people living with HIV who are also at elevated risk for hepatitis co-infection — and for whom untreated hepatitis can accelerate serious, life-threatening liver disease.

What Is Viral Hepatitis?

Hepatitis is an inflammation of the liver, most commonly caused by one of three viruses: hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV). Each virus is distinct in how it spreads, how it progresses, and how it is treated.

Hepatitis A is transmitted primarily through contaminated food and water, or close contact with an infected person. It is typically an acute illness that resolves on its own, but for people with underlying liver disease — including those with HIV — it can cause severe complications. A safe and effective vaccine is available and recommended for all people living with HIV.

Hepatitis B is a bloodborne virus transmitted through sexual contact, sharing needles or injection equipment, or from mother to child at birth. Because HBV and HIV share the same primary routes of transmission, a significant proportion of people at risk for HIV are also at risk for HBV. People with HIV who acquire HBV are at substantially increased risk for liver-related disease and death. Fortunately, an effective vaccine exists, and certain HIV antiretroviral medications also have activity against HBV, allowing treatment of both infections simultaneously.

Hepatitis C is a bloodborne pathogen spread primarily through direct contact with infected blood — most commonly through sharing injection drug equipment. Sexual transmission can also occur, particularly among men who have sex with men (MSM) living with HIV. According to the CDC, approximately 21% of adults with HIV who were tested for hepatitis C tested positive — and among people who inject drugs and have HIV, HCV co-infection rates reach an estimated 62% to 80%.

Why Co-Infection Is So Serious

When HIV and hepatitis C or hepatitis B occur together, the consequences are more severe than either infection alone. Here is why:

Accelerated liver damage. HCV-related liver injury progresses significantly more rapidly in people co-infected with HIV. What might take decades to cause cirrhosis in a person with HCV alone can progress much faster when HIV is present and immune function is compromised.

Complicated treatment decisions. Both HIV and HBV require careful management when they occur together. Some HIV antiretroviral medications have activity against HBV, which means stopping HIV treatment without medical guidance can cause a dangerous "flare" of hepatitis B. Clinicians must account for both infections when designing a treatment plan.

Increased mortality risk. Liver disease is one of the leading causes of death among people living with HIV in the United States. Co-infection with HCV or HBV dramatically increases that risk — making early detection and treatment essential.

Barriers to HIV treatment. Hepatitis co-infection can complicate the management of HIV itself, affecting which antiretroviral medications are appropriate and how the immune system responds to treatment.

The Good News: Both Are Treatable

Despite the serious risks, there is genuine cause for hope. Medical advances over the past decade have transformed the treatment landscape for both HIV and hepatitis.

For hepatitis C, direct-acting antiviral (DAA) medications — taken orally for 8 to 12 weeks — now achieve cure rates above 95%, even in people co-infected with HIV. The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) recommend that all people co-infected with HIV and HCV receive timely DAA treatment. This is a genuine cure, not just management.

For hepatitis B, while there is no cure, effective long-term suppressive therapy can prevent liver damage, reduce the risk of liver cancer, and allow people to live full, healthy lives. Several HIV antiretroviral medications — including tenofovir — also suppress HBV, making combination treatment both practical and effective.

For hepatitis A, vaccination is the most powerful tool. The CDC recommends that all people living with HIV receive the hepatitis A vaccine series, followed by post-vaccination testing to confirm an immune response, since HIV can reduce vaccine effectiveness.

Who Should Be Tested?

The CDC recommends the following for people living with HIV:

All people with HIV should be vaccinated against hepatitis A and hepatitis B and tested to confirm immune response after vaccination.

All people with HIV should be tested for hepatitis B (HBsAg, anti-HBs, and anti-HBc) at entry into care.

All people with HIV should be tested for hepatitis C at entry into care, and periodically thereafter if ongoing risk factors are present — including injection drug use or unprotected sex among MSM.

If you have not been tested for hepatitis B or C since your HIV diagnosis, or if you have new risk factors, talk to your healthcare provider or contact Project Health Outreach. Our patient navigators can help connect you with testing and care.

Addressing Disparities in Treatment Access

In Florida, access to hepatitis C treatment has historically been uneven. A study published in 2020 found that only 8% of Medicaid-enrolled Floridians with HCV received direct-acting antiviral treatment, despite changes in prior authorization requirements. Disparities in treatment access were found across racial, ethnic, and geographic lines.

This is precisely the kind of gap that community health organizations like Project Health Outreach exist to close. Our patient navigators work to connect individuals with the care they need — including hepatitis testing, linkage to treatment, and assistance navigating insurance and financial assistance programs.

What You Can Do Right Now

Whether you are living with HIV, at risk for HIV, or simply want to protect your liver health, here are four concrete steps you can take this Hepatitis Awareness Month:

Get tested. If you do not know your hepatitis B and C status, find out. Testing is fast, confidential, and often free. Project Health Outreach can connect you with free testing sites in Pasco, Pinellas, and Hillsborough Counties.

Get vaccinated. If you have not received the hepatitis A and hepatitis B vaccine series, ask your provider today. These vaccines are safe, effective, and recommended for everyone living with HIV.

Talk to your provider. If you are living with HIV and have not been screened for hepatitis co-infection, raise it at your next appointment. If you have been diagnosed with HCV, ask about direct-acting antiviral treatment — a cure may be within reach.

Spread the word. Stigma and lack of awareness are among the biggest barriers to testing and treatment. Share this post, talk to people you care about, and help us build a community where no one faces these diseases alone.

Project Health Outreach Is Here for You

Project Health Outreach Inc. is a nurse-led 501(c)(3) nonprofit organization founded by Deborah Nicolo, MSN, APRN, providing free HIV/STI education, PrEP navigation, and patient navigation services across the Tampa Bay region. Our services are free, confidential, and built for the communities that need them most.

If you have questions about hepatitis, HIV, or how to access testing and treatment in our area, contact us at 727-226-7844 or visit our Get Tested page [blocked] to find a free testing location near you.

This Hepatitis Awareness Month, let us commit to knowing our status, protecting our health, and supporting one another. Together, we can end the epidemics of both HIV and viral hepatitis in our community.

Sources: CDC — Viral Hepatitis Among People with HIV (January 2025); CDC — About Viral Hepatitis Awareness Month; AASLD/IDSA HCV Guidance; Direct-Acting Antiviral Treatment Use Among Florida Medicaid Patients, PubMed 2020; CDC Ending the HIV Epidemic Initiative.