Intertwined viruses representing HIV and Hepatitis B within a human silhouette.

HIV and Hepatitis B: Unmasking the Risks and Protecting Your Health

Lena Kashyap in Health & Wellness December 2025 • 5 min read.

"New research sheds light on the complexities of HIV/HBV co-infection, emphasizing the importance of long-term monitoring and tailored treatment strategies."

For individuals living with HIV, co-infection with Hepatitis B virus (HBV) presents a significant health challenge. While advancements in antiretroviral therapy (ART) have dramatically improved the lives of people with HIV, the impact of HBV co-infection on long-term health outcomes requires careful consideration. Recent research has begun to unravel the complexities of this co-infection, highlighting the need for ongoing monitoring and tailored treatment approaches.

Historically, studies on HIV and HBV co-infection have sometimes yielded conflicting results, particularly in resource-limited settings. Some studies have suggested that HBV co-infection increases the risk of liver-related complications and mortality among people with HIV, while others have found that HIV disease progression is the primary driver of mortality, overshadowing the impact of HBV.

The implementation of the "treat all" strategy for HIV infection in low-income countries marks a turning point. This initiative aims to provide immediate ART to everyone diagnosed with HIV, regardless of their CD4 count. As access to ART expands, the specific impact of HBV co-infection on clinical outcomes may become more evident, necessitating a deeper understanding of the interplay between these two viruses.

Decoding the Risks: What Factors Increase Mortality?

Intertwined viruses representing HIV and Hepatitis B within a human silhouette.

A recent study published in Clinical Infectious Diseases investigated the risk factors associated with one-year mortality among HIV-infected individuals, considering the impact of HBV co-infection. Using multivariable Cox proportional hazard regression analyses, the researchers identified several key factors that significantly influenced mortality rates. Notably, the study population consisted of individuals initiating ART, reflecting real-world clinical scenarios.

The study revealed several independent risk factors for increased mortality: Those percentages represented below are risk factors based on study from source text:

Hepatitis B Surface Antigen (HBsAg) Positivity: Individuals who tested positive for HBsAg, indicating active HBV infection, had a higher risk of mortality compared to those who were HBsAg negative. This finding underscores the importance of screening for HBV co-infection in all people living with HIV.
Advanced WHO Stage: Patients presenting with more advanced HIV disease (WHO stage 3 or 4) experienced significantly higher mortality rates than those in earlier stages (WHO stage 1 or 2). This highlights the critical role of early HIV diagnosis and treatment initiation.
Low CD4 Cell Count: A CD4 cell count below 200 cells/µL was strongly associated with increased mortality. CD4 cells are crucial for immune function, and a low count indicates a weakened immune system, making individuals more vulnerable to opportunistic infections.
Low Body Mass Index (BMI): A BMI below 18.5 kg/m², indicative of being underweight, was a significant predictor of mortality. Malnutrition can compromise immune function and overall health, increasing susceptibility to infections and other complications.
Male Sex: Men had a higher risk of mortality compared to women in the study. This disparity may be related to differences in healthcare-seeking behavior, adherence to treatment, or biological factors.

These findings emphasize the importance of a comprehensive approach to managing HIV, including early diagnosis, prompt ART initiation, screening and management of HBV co-infection, nutritional support, and targeted interventions to address sex-specific health disparities. Continuous monitoring of CD4 cell counts and viral load is essential for assessing treatment effectiveness and identifying individuals at higher risk.

The Future of HIV/HBV Research: Monitoring and Long-Term Strategies

As the "treat all" strategy for HIV becomes more widespread, it is crucial to monitor the long-term impact of HBV co-infection on clinical outcomes. Researchers emphasize the need for long-term data from cohorts with intensive retention strategies to better understand the interplay between HIV and HBV. This information will be vital for developing targeted interventions to improve the health and survival of individuals with HIV/HBV co-infection. Further research should focus on identifying the specific causes of mortality in co-infected individuals, including liver-related diseases and other complications. Ultimately, a comprehensive understanding of these factors will pave the way for more effective prevention, diagnosis, and treatment strategies, leading to improved health outcomes for people living with HIV and HBV.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/cid/ciy307, Alternate LINK

Title: Reply To Hector Et Al

Subject: Infectious Diseases

Journal: Clinical Infectious Diseases

Publisher: Oxford University Press (OUP)

Authors: Gérard-Menan Kouamé, Anders Boyd, Raoul Moh, Serge Paul Eholié, Christine Danel, Karine Lacombe, Xavier Anglaret

Published: 2018-04-18

Everything You Need To Know

What does HBsAg positivity mean for those with HIV?

Individuals who test positive for Hepatitis B Surface Antigen (HBsAg) have a higher risk of mortality when co-infected with HIV. This indicates an active HBV infection, and the higher mortality risk emphasizes the importance of screening for HBV co-infection in all people living with HIV. The presence of HBsAg signals that the Hepatitis B virus is actively replicating in the body, potentially leading to liver damage and other complications, which can increase the risk of mortality.

What does the WHO stage have to do with HIV and mortality?

If an individual has advanced WHO Stage 3 or 4 HIV disease they will experience significantly higher mortality rates. These WHO stages represent more advanced HIV disease. The higher mortality rates in these stages highlight the importance of early HIV diagnosis and immediate treatment initiation. As the disease progresses, the immune system weakens, making individuals more susceptible to opportunistic infections and other complications, ultimately increasing the risk of death.

Why is CD4 count so important in the context of HIV?

A CD4 cell count below 200 cells/µL is strongly associated with increased mortality. CD4 cells are crucial for immune function, and a low count indicates a weakened immune system, making individuals more vulnerable to opportunistic infections. This is a critical measure of immune health in people living with HIV. Monitoring the CD4 count allows healthcare providers to assess the effectiveness of antiretroviral therapy (ART) and identify individuals at higher risk of complications and mortality. When the CD4 count drops below a certain threshold, the body becomes increasingly susceptible to infections and other diseases.

How does BMI relate to HIV and mortality?

A Body Mass Index (BMI) below 18.5 kg/m², indicative of being underweight, is a significant predictor of mortality. Malnutrition can compromise immune function and overall health, increasing susceptibility to infections and other complications. A low BMI signifies that an individual may lack adequate nutrition. This can weaken the immune system and make it harder for the body to fight off infections, increasing the risk of mortality. Nutritional support and interventions are essential for these individuals.

Were there any differences in mortality risk based on sex?

Men had a higher risk of mortality compared to women in the study. This disparity may be related to differences in healthcare-seeking behavior, adherence to treatment, or biological factors. While the exact reasons for this disparity are not fully understood, it highlights the need for targeted interventions to address sex-specific health disparities in the management of HIV/HBV co-infection. These interventions can include tailoring treatment plans and providing support to improve outcomes for all individuals.