According to HIV.gov, coinfection is when a person has two or more infections at the same time. Common coinfections that affect people living with HIV (PLWH) are hepatitis B and C and tuberculosis. People living with HIV should also receive the flu, COVID and mpox vaccines.
Hepatitis B and C can be transmitted sexually or by injection drug use. Hepatitis A is less common among PLWH and a vaccine is available for it. If left untreated, these infections can lead to liver disease, liver cancer, and liver failure. Hepatitis B can be prevented with a vaccine – there is no cure for hepatitis B, but treatment can delay or limit liver damage. There is no vaccine for hepatitis C, but treatment cures about 97% of people, including those with HIV, with 8-12 weeks of oral therapy. Everyone living with HIV should be tested for hepatitis B and C.
HIV weakens the immune system, increasing the risk of tuberculosis (TB) in people with HIV. TB is considered an AIDS-defining condition, meaning if an HIV-positive person has it, they also have AIDS. In the United States, where HIV medicines are widely used, fewer PLWH have TB disease than in the past; however, TB disease still affects many PLWH in the U.S. Worldwide, TB is one of the leading causes of death among people with HIV – that’s why it is important to be tested for TB and for those who test positive to begin treatment.
Flu, COVID, Mpox and Other Vaccines Can Reduce Risks
Risks posed by some medical conditions can be prevented or reduced by vaccines. These conditions are called vaccine preventable diseases. Some examples of these diseases are the flu, COVID, mpox, hepatitis A and B, meningitis, shingles, and pneumococcal infections.
Vaccinations can provide protection against these conditions. Be sure you are up-to-date with all your regular vaccines. Talk with your healthcare provider who knows about your HIV status about flu, COVID, mpox, hepatitis A and B, and meningococcal vaccines. In addition, vaccines for shingles, human papillomavirus (HPV), and pneumococcal infections may be recommended for you, depending upon your age and medical history. If you plan to travel outside the United States, check with CDC Travelers’ Health or a travel health specialist to see if additional vaccines are recommended.
According to HIV.gov, PLWH are at high risk of developing serious flu-related complications, especially people who have a very low CD4 cell count or who are not taking medicine to treat HIV. Getting a flu shot every year is the best way to protect yourself and your loved ones against the flu, which can cause serious complications. The flu vaccine provides safe and effective immunity throughout the flu season.
We are still learning about COVID and how it affects people with HIV. Older age and underlying medical conditions can make people more likely to get very sick if they get COVID. This is especially true for people with advanced HIV or people with HIV who are not on treatment. People at increased risk for severe illness should take precautions (including getting vaccinated and wearing a well-fitting mask in crowded indoor areas) to protect themselves and others from COVID.
If you have symptoms, take a COVID test immediately. If the test is positive, follow CDC’s steps to take when you are sick. Keep taking your HIV medicine as prescribed. If you test positive and are more likely to get very sick, treatments are available that can reduce your chances of hospitalization and death. Contact a healthcare provider right away. Some COVID treatments can interact with antiretroviral therapy (ART) used to treat HIV. Let your healthcare providers know before starting COVID treatment.
CDC recommends everyone stay up to date with COVID vaccines for their age group. This includes people with HIV, regardless of their CD4 count or viral load. People who are moderately or severely immunocompromised (such as those with advanced or untreated HIV) have different recommendations for COVID vaccines. COVID vaccines are safe for people with HIV. There is no evidence that COVID vaccines interfere with ART or with PrEP to prevent HIV.
We do not know if having HIV increases the likelihood of getting infected with mpox (monkeypox) virus if exposed; however, we do know that people with advanced HIV are at increased risk of severe mpox if they get the mpox virus. CDC recommends that anyone with HIV get vaccinated against mpox.
If you contract mpox, treatments are safe and may be used to treat people who are more likely to get severely ill with mpox. If you have HIV, ask your healthcare provider about what treatment options you should consider. Based on current knowledge, mpox treatments have very few possible interactions with HIV medicines. If you have HIV, let your health care provider know before starting mpox treatment.