Hepatitis A to E in People with HIV: A Virus-Specific Review of Prevention and Treatment.
Journal
Infectious diseases and therapy
Journal Volume
15
Journal Issue
2
ISSN
2193-8229
Date Issued
2026-02
Author(s)
Huang, Miao-Hui
Tsai, Tsung-Yu
Chen, Guan-Jhou
Huang, Sung-Hsi
Abstract
People with HIV (PWH) are disproportionately affected by viral hepatitis as a result of overlapping transmission routes, reduced vaccine immunogenicity, altered disease progression, and unique therapeutic considerations under HIV-related immunosuppression. Although the scale-up of antiretroviral therapy (ART) and direct-acting antivirals (DAAs) has significantly improved outcomes, viral hepatitis remains a major cause of liver-related morbidity and mortality in this population. This virus-specific review summarizes current knowledge and recent advances in the epidemiology, vaccination, and treatment strategies for hepatitis A through E (i.e., hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV); HAV-HEV) among PWH. HAV has re-emerged in community outbreaks among men who have sex with men (MSM), with prolonged or atypical presentations in people who are immunocompromised, underscoring the need for improved vaccination coverage and durable immunity. HBV coinfection remains the most clinically significant challenge, requiring lifelong dual-active ART and raising persistent concerns about poor vaccine response and long-term protection. HCV has become curable with DAAs, yet reinfection-particularly among MSM and people who inject drugs-remains a major barrier to microelimination. HDV, though less prevalent, causes severe liver disease and now has promising targeted therapies under clinical use or investigation. HEV is increasingly recognized as an underdiagnosed pathogen and potentially chronic infection in people who are immunocompromised, with limited diagnostic availability and global accessibility to effective vaccine. Effective hepatitis prevention and treatment in PWH must address the immunologic, clinical, and virologic nuances of each virus. Integrated models of care that combine HIV and hepatitis services are essential to improving long-term liver health, reducing disparities, and advancing toward global goals of viral hepatitis elimination.
Subjects
Direct-acting antiviral
Fecal–oral transmission
Immunization
Microelimination
Outbreak
Sexually transmitted infection
Type
review article