Coinfection means that someone is infected with more than one disease at the same time. Common types of coinfection for people living with HIV include hepatitis B, hepatitis C, tuberculosis, syphilis
and other sexually transmitted infections. People living with HIV are at an increased risk of coinfection, which can be due to a compromised immune system. It can also be because the routes of
transmission of some of these diseases are the same as HIV, including via the blood or through body fluids, such as semen and vaginal fluids.

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Preventing or managing coinfection;

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• It is recommended that anyone diagnosed with HIV should be tested for possible coinfections;

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• Depending on risk, it is also advised that annual checks for coinfections take place – early diagnosis is important for good clinical outcomes;

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• Speak with your healthcare professional if you have concerns about any aspect of your treatment for coinfections;

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• If you have had a coinfection in the past but are no longer infected you are not protected from contracting a coinfection again in the future.

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Hepatitis B​

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Hepatitis B is a viral infection caused by the hepatitis B virus that attacks the liver.

Hepatitis B can cause either acute or chronic disease. Most people can naturally clear the hepatitis B virus and it will only stay in the body for around one to three months. This is known as acute hepatitis B. For around 5% of adults the virus will stay in the body for six months or longer, which is known as chronic hepatitis B.

Hepatitis B can be transmitted through blood and body fluids such as semen and vaginal fluids, so it can be contracted:

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•    during unprotected sex, including anal and oral sex
•    by sharing needles to inject drugs

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A mother can also pass on the hepatitis B virus to her newborn baby, but  the infection can be prevented if the baby is vaccinated immediately after birth.

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Symptoms of hepatitis B​

Many people do not realise they have been infected with hepatitis B because it takes between 40 and 160 days for any symptoms to develop after exposure to the hepatitis B virus, if at all. For those who do experience symptoms these can include:

• Feeling sick

• Being sick

• Lack of appetite

• Flu-like symptoms, such as tiredness, general aches and pains, and headaches

• Yellowing of the skin and eyes (jaundice)

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Treating hepatitis B

For acute hepatitis B – there is currently no specific treatment other than using painkillers to relieve symptoms.

For chronic hepatitis B – treatment depends on how badly your liver is affected. It can be treated using medications designed to slow the production of the virus and prevent damage to the liver. Most people with chronic hepatitis B have very little damage. However, around 20% of people with chronic hepatitis B will go on to develop scarring of the liver (cirrhosis), which can take 10 to 20 years to develop. Around 1 in 10 people with cirrhosis will develop liver cancer.

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​Key facts about hepatitis B and HIV

• Approximately 10% of people living with HIV are infected with hepatitis B

• People living with HIV are half as likely to spontaneously clear the hepatitis B virus

• People living with HIV are 10 times more likely to go on and develop chronic hepatitis B

• Regular blood test screening for hepatitis B is recommended for people living with HIV

• There is a vaccine available for those who are at higher risk of hepatitis B including those living with HIV. It is 95% effective in preventing hepatitis B infection

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If you have HIV and hepatitis B requiring anti-hepatitis B treatment, the European AIDS Clinical Society (EACS) guidelines recommend that you start treatment when your CD4 cell count is 500 cells/mm3 or more.   

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Hepatitis C​

Hepatitis C is a viral infection caused by the hepatitis C virus that attacks the liver.

Like hepatitis B, hepatitis C can cause either acute or chronic disease. It is estimated that 90% of those infected with hepatitis C are not aware of their infection.

Hepatitis C is most commonly passed on through contact with infected blood. Some groups are at an increased risk of contracting hepatitis C, including:

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• People who inject drugs

• Sex workers

• Men who have sex with men

• People living with HIV

• Migrants

• People on long-term haemodialysis

• People who have received blood, blood products or organs before screening for hepatitis C was implemented, or where screening was not yet widespread

• Healthcare workers

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Symptoms of hepatitis C​
Only 20% of people with hepatitis C experience symptoms. Symptoms include:

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Acute hepatitis C

• Fever

• Fatigue

• Decreased appetite

• Nausea and/or vomiting

• Abdominal pain

• Dark urine

• Grey-coloured faeces

• Joint pain

• Jaundice

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Chronic hepatitis C

• Chronic liver disease

• Cirrhosis

• Liver 

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​Treating hepatitis C.
Hepatitis C has traditionally been treated with a combination therapy of interferon and ribavirin:

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• Interferon fights the infection

• Ribavirin makes the interferon more effective

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New direct-acting antivirals (DAAs) have shown to shorten treatment duration from 24–72 weeks to 12–24 weeks and approximately 80%–100% of people with hepatitis C can be cured.

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Key facts about hepatitis C and HIV

• As the hepatitis C virus is a blood-borne virus, coinfection with HIV is common

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• 50% to 90% of people who inject drugs and are HIV positive also have hepatitis C

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• It is recommended that people living with HIV are screened for hepatitis C

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• Coinfection with HIV and hepatitis C is a risk factor for hepatocellular carcinoma (liver cancer)

 

Early HIV treatment is important for people living with both HIV and hepatitis C as HIV can speed up the progression of liver damage.

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Tuberculosis​

 

Tuberculosis (TB) is an infectious disease that is caused by a bacterium called Mycobacterium tuberculosis. TB primarily affects the lungs, but it can also affect organs in the central nervous system, lymphatic system and circulatory system among others.
A person can have active or inactive (latent) TB. In people with active TB it can be transmitted through coughing, sneezing or spitting. People nearby may breathe in the TB bacteria and become infected. People with inactive (or latent) TB cannot spread TB. Left untreated, each person with active TB will infect on average between 10 and 15 people each year.

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Symptoms of TB

​​In healthy people, TB often causes no symptoms as the immune system can fight the bacteria. For those who do experience symptoms these can include:

 

• Bad cough

• Chest pain

• Weakness/fatigue

• No appetite/weight loss 

• Chills

• Fever/sweating at night

• Coughing up blood/sputum

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Treating TB

TB can be cured, even in people living with HIV. Treatment for active TB usually involves a variety of antibiotics, taken over a minimum of a six month period.

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Key facts about TB and HIV

• It is estimated that one-third of people living with HIV are coinfected with TB;

• The risk of developing TB is estimated to be between 12–20 times greater in people living with HIV;

• TB is harder to diagnose in people living with HIV;

• TB bacteria accelerate HIV to AIDS and HIV infection is the most potent risk factor for converting latent TB into active TB.

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HIV treatment should be initiated immediately, regardless of CD4 count, for anyone coinfected with HIV and TB.

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Syphilis and Sexually Transmitted Infections (STIs)​​​

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Syphilis is a complex sexually transmitted infection (STI) caused by a bacterium called Treponema pallidum.

Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex. Preventative measures, such as condoms, should be used to avoid syphilis infection. Occasionally,  the disease can be passed to another person through prolonged kissing or close bodily contact. Pregnant women can transmit syphilis to their baby.

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Symptoms of syphilis

Many people infected with syphilis do not have any symptoms for years yet remain at risk for late complications if they are not treated.

Symptoms of early or primary syphilis

• One or more sores develop on the genitals or in or around the mouth – these sores are hard and painless;

• On average they occur three weeks after exposure and even without treatment they heal within six weeks

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Symptoms of secondary syphilis

• A whole body rash, including on the palms of the hands and soles of the feet can occur within six weeks to six months after exposure;

• Other symptoms include: swollen lymph glands, tiredness, headaches and fever;

• Symptoms may disappear within a few weeks.

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Symptoms of the latent phase

• This is where the infection lies dormant (inactive) without causing symptoms;

• Without treatment, there is a risk that latent syphilis will progress into tertiary syphilis.

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Symptoms of tertiary syphilis

• The symptoms of tertiary syphilis can begin years after infection

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• In this stage, syphilis can cause severe problems to the heart, brain, and nerves that can result in paralysis, blindness, dementia, deafness, and even death if it is not treated

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Treating syphilis

Primary and secondary syphilis can be successfully treated with penicillin or other antibiotics. Later stages of the disease need to be treated with penicillin injections.

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​Key facts about syphilis and HIV

• For people with HIV, having an STI can increase viral loads both in the blood and body fluids (such as semen and vaginal fluids), subsequently making people more infectious;

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• Syphilis treatment has had a higher failure rate in people living with HIV;

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• It is possible that HIV speeds up the course of syphilis.