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HIV/AIDS-Related Opportunistic Infections and Coinfections

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HIV and Hepatitis B

Last Reviewed: July 24, 2017

Key Points

  • Hepatitis B is a liver disease caused by the hepatitis B virus (HBV).
  • HBV is spread through contact with the blood, semen, or other body fluid of a person who has HBV. Among adults in the United States, HBV is spread mainly through sexual contact.
  • According to the Centers for Disease Control and Prevention (CDC), approximately 10% of people with HIV in the United States also have HBV. Infection with both HIV and HBV is called HIV/HBV coinfection.
  • People with HIV/HBV coinfection should be treated for both diseases.

What is hepatitis B?

Hepatitis B is a liver disease caused by the hepatitis B virus (HBV). The abbreviation HBV can stand for either the virus or the disease it causes.

HBV can be a short-term (acute) or a long-term (chronic) illness:

  • Acute HBV occurs within 6 months after a person is exposed to HBV. Acute HBV can (but does not always) lead to chronic HBV.
  • Chronic HBV is a lifelong disease. Without treatment, chronic HBV can cause liver cancer or liver damage that leads to liver failure.

HBV is a contagious disease that can spread from person to person.

How does HBV spread from person to person?

HBV is spread through contact with the blood, semen, or other body fluid of a person who has HBV. Among adults in the United States, HBV is spread mainly through sexual contact.

HBV can also spread from person to person in the following ways:

  • By sharing needles or other injection drug equipment ("works") with someone who has HBV
  • By sharing razors, toothbrushes, or similar personal items with someone who has HBV
  • From an accidental prick or cut from an HBV-contaminated needle or other sharp object
  • From a mother who has HBV to her child during childbirth

What is the connection between HIV and HBV?

Both HIV and HBV spread in semen, blood, or other body fluids. Therefore, the main risk factors for HIV and HBV are the same: unprotected sex (sex without a condom) and injection drug use.

According to the Centers for Disease Control and Prevention (CDC), approximately 10% of people with HIV in the United States also have HBV. Infection with both HIV and HBV is called HIV/HBV coinfection.

Chronic HBV advances faster to cirrhosis, end-stage liver disease, and liver cancer in people with HIV/HBV coinfection than in people with only HBV infection. But chronic HBV doesn’t appear to cause HIV to advance faster in people with HIV/HBV coinfection.

Can HBV infection be prevented?

Yes. The best way to prevent HBV infection is to get the hepatitis B vaccine

CDC recommends that people with HIV and people who are at risk for HIV get the HBV vaccine (or the combined hepatitis A virus [HAV]/HBV vaccine). The housemates and sexual partners of people with HBV should get the HBV vaccine too.

People, including people with HIV, can also take the following steps to reduce their risk of HBV infection:

  • Use condoms during sex to reduce the risk of HBV infection and infection with other sexually transmitted diseases such as gonorrhea and syphilis.
  • Don’t inject drugs. But if you do, don’t share needles, syringes, or other drug injection equipment.
  • Don’t share toothbrushes, razors, or other personal items that may come in contact with another person’s blood.
  • If you get a tattoo or body piercing, make sure the instruments used are sterile.

Should people with HIV get tested for HBV?

Every person who has HIV should get tested for HBV. Testing can detect HBV infection even when a person has no symptoms of the disease.

There are several HBV blood tests. Results of different tests have different meanings. For example, a positive hepatitis B surface antigen (HBsAg) test result shows that a person has acute or chronic HBV and can spread the virus to others.

To learn more about HBV tests, visit the CDC webpage Hepatitis B FAQs for the Public (look under the heading “Tests”).

What are the symptoms of HBV infection?

Some people with acute HBV don’t have symptoms. But some people can have signs of HBV soon after becoming infected. Mild to severe symptoms of acute HBV can include the following:

  • Loss of appetite
  • Tiredness
  • Vomiting
  • Fever
  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Joint and stomach pain
  • Jaundice (yellowing of the skin or whites of the eyes)

Some people with chronic HBV don’t have any symptoms for many years. Abnormal results on liver function tests may be the first sign of chronic HBV infection.

What is the treatment for HBV?

In general, HBV is treated with antiviral medicines. The medicines work to slow down or stop HBV from damaging the liver.

People with HIV/HBV coinfection should be treated for both infections. Some HIV medicines are effective at treating both HIV and HBV.

The choice of medicines to treat HIV/HBV coinfection depends on the person. For example, some people may take only HIV medicines, including some that are also effective against HBV. Other people may take HIV medicines and an HBV antiviral medicine. If you have HIV/HBV coinfection, talk to your health care provider about the best medicines for you.

Learn more about HIV and HBV. This fact sheet is based on information from the following sources:

From CDC:

From the Department of Health and Human Services (HHS): 

From the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

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