HIV and Viral Hepatitis Co-Infection

A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "Human Virology and Viral Diseases".

Deadline for manuscript submissions: closed (31 March 2026) | Viewed by 3933

Special Issue Editors


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Guest Editor
National HIV/AIDS Research Center, Istituto Superiore di Sanità, 00161 Rome, Italy
Interests: HIV infection and pathogenesis; HIV-1–host interaction; HCV/HIV co-infection
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Special Issue Information

Dear Colleagues,

Co-infections with hepatitis viruses A to E and human immunodeficiency virus (HIV) present significant public health challenges worldwide and contribute to a significant amount of morbidity and mortality among people living with HIV (PLWH). The management of these co-infections normally includes the use of multiple antiviral and antiretroviral drugs which may interact, limiting therapeutic efficacy or increasing toxicities. Hepatitis A (HAV) and hepatitis E (HEV) viruses are oro-fecal transmissible diseases and mostly produce acute self-limited episodes, but the changing demographic outbreaks among vulnerable populations have contributed to substantial increases in the reported cases of these co-infections in PLWH. Furthermore, the immunosuppression derived from HIV infection can modify the immune response to HAV and HEV infections, causing acute liver dysfunction or development into a chronic infection. Chronic hepatitis B (HBV), C (HCV), and D (HDV) are frequent in PLWH as these viruses share a similar transmission route. HBV vaccination results in protective seroconversion, but it may remain suboptimal in PLWH; therefore, new strategies warrant further consideration. Progression to liver cirrhosis, increased hepatic decompensation, and the development of hepatocellular carcinoma are mostly related to HCV. Although direct acting antivirals can now achieve sustained virological response in nearly almost co-infected individuals, further evidence is needed on the subsequent resolution of liver inflammation and systemic immune activation, as well as the latent HIV reservoir in PLWH.

For this Special Issue, research articles, review articles, as well as short communications are welcome to be submitted to provide novel insights into the evolving epidemiology, clinical aspects, and new preventive and therapeutic approaches of HIV and viral hepatitis co-infections for the better management and care of PLWH.

Dr. Sonia Moretti
Dr. Ivan Schietroma
Guest Editors

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Keywords

  • HIV
  • hepatitis A
  • hepatitis B
  • hepatitis C
  • hepatitis delta
  • hepatitis E
  • co-infection
  • antiviral therapy

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Published Papers (3 papers)

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Research

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9 pages, 228 KB  
Article
Beyond Foodborne HAV: Sexual Transmission Drives a New Wave of Cases in Romania
by Adrian Paun, Irina Ianache, Ruxandra Moroti, Georgiana Pomohaci, Gratiela Tardei, Mike Youle, Simona Ruta and Cristiana Oprea
Viruses 2026, 18(2), 215; https://doi.org/10.3390/v18020215 - 6 Feb 2026
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Abstract
Background: In 2022, Romania experienced a sharp increase in hepatitis A virus (HAV) infections, with evidence of predominant fecal–oral transmission through sexual contact, raising concern for an outbreak among men who have sex with men (MSM). Methods: We conducted a prospective [...] Read more.
Background: In 2022, Romania experienced a sharp increase in hepatitis A virus (HAV) infections, with evidence of predominant fecal–oral transmission through sexual contact, raising concern for an outbreak among men who have sex with men (MSM). Methods: We conducted a prospective multicenter study between 1 March 2022 and 1 March 2023 in two tertiary hospitals in Bucharest. HAV infection was defined by a compatible clinical presentation, elevated liver enzymes, and positive anti-HAV IgM serology. Clinical and laboratory characteristics were compared by transmission route and HIV status. Results: A total of 191 patients were diagnosed with HAV, including 105 MSM and 86 with foodborne transmission. All were unvaccinated. Most patients were male (82.2%), with a median age of 30 years (IQR 24–38). MSM were significantly younger and reported higher-risk sexual behaviors, including chemsex and multiple or occasional partners (p < 0.0001). Among MSM, 48 (25.1%) were living with HIV, most with preserved immune status and undetectable viral loads. Clinical manifestations were similar across groups, with jaundice being most frequent (89.5%). However, MSM exhibited more severe hepatocellular injury, reflected by higher ASAT and ALAT levels and lower prothrombin concentration, independent of HIV status. MSM were also more likely to have concomitant sexually transmitted infections, including syphilis and mpox (p < 0.001). Disease was predominantly mild, although MSM had longer hospital stays. Conclusions: The 2022 HAV surge in Romania was driven by both sexual and foodborne transmission. Targeted HAV vaccination, along with integrated sexual health services and harm-reduction strategies, is essential to prevent future outbreaks. Full article
(This article belongs to the Special Issue HIV and Viral Hepatitis Co-Infection)
10 pages, 529 KB  
Article
Worsening of Controlled Attenuation Parameter and Metabolic Profile After HCV Cure in People with HIV as a Sign of Steatosis
by Alessia Siribelli, Sara Diotallevi, Laura Galli, Camilla Muccini, Giulia Morsica, Riccardo Lolatto, Tommaso Clemente, Emanuela Messina, Costanza Bertoni, Caterina Uberti-Foppa, Antonella Castagna and Hamid Hasson
Viruses 2025, 17(7), 906; https://doi.org/10.3390/v17070906 - 26 Jun 2025
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Abstract
In HCV-coinfected people with HIV (PWH), there are still conflicting data regarding the long-term metabolic impact of HCV eradication. The aim of the study is to investigate long-term changes in controlled attenuation parameter (CAP) and metabolic profile after sustained virological response (SVR) post-direct [...] Read more.
In HCV-coinfected people with HIV (PWH), there are still conflicting data regarding the long-term metabolic impact of HCV eradication. The aim of the study is to investigate long-term changes in controlled attenuation parameter (CAP) and metabolic profile after sustained virological response (SVR) post-direct acting antivirals (DAAs) in PWH. This is a retrospective observational study including individuals with HIV/HCV coinfection, followed as outpatients at San Raffaele Hospital, who achieved SVR post-DAAs. Individuals were assessed for metabolic parameters before and after the start of DAAs. Univariate and multivariate mixed linear models were calculated to estimate crude mean changes in CAP, metabolic parameters, and weight; slopes were reported with the corresponding 95% confidence intervals (95% CI). Overall, during a median follow-up of 4.02 years (interquartile range, IQR 3.04–4.80), the mean percent increase in CAP was 2.86/year (p < 0. 0001), and the mean decrease in stiffness was –4.28 (p = 0.003). Additionally, total cholesterol (p < 0.0001), high-density lipoprotein (HDL) cholesterol (p = 0.001), triglycerides (p < 0.0001), glucose (p < 0.0001), and Body Mass Index (BMI) (p < 0.0001) increased over time. A long-term follow-up in PWH with SVR post-DAAs showed an overall significant increase in CAP and worsening of the metabolic profile, suggesting a higher risk of developing liver steatosis and metabolic alterations over time. Full article
(This article belongs to the Special Issue HIV and Viral Hepatitis Co-Infection)
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Review

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23 pages, 734 KB  
Review
A Review of Human Immunodeficiency Virus and Hepatitis B Virus Co-Infection in Botswana
by Linda Mpofu-Dobo, Kebaneilwe Lebani, Jason T. Blackard, Sikhulile Moyo, Motswedi Anderson and Simani Gaseitsiwe
Viruses 2026, 18(5), 523; https://doi.org/10.3390/v18050523 - 30 Apr 2026
Viewed by 1426
Abstract
Hepatitis B virus (HBV) remains a leading cause of chronic liver disease worldwide, contributing to cirrhosis and hepatocellular carcinoma. Sub-Saharan Africa accounts for an estimated 68% of incident HBV infections, where co-infection with human immunodeficiency virus (HIV) is common and associated with poorer [...] Read more.
Hepatitis B virus (HBV) remains a leading cause of chronic liver disease worldwide, contributing to cirrhosis and hepatocellular carcinoma. Sub-Saharan Africa accounts for an estimated 68% of incident HBV infections, where co-infection with human immunodeficiency virus (HIV) is common and associated with poorer clinical outcomes. In Botswana, limited HBV screening and the absence of established HBV management guidelines persist despite reported HIV-HBV co-infection rates ranging from 1.1% to 10.6%. This scoping review aimed to summarise existing research on HBV and HIV-HBV co-infection in Botswana and assess clinical and policy implications. Following PRISMA methodology, searches were conducted across PubMed, Google Scholar, Semantic Scholar, and Consensus databases. Thirty eligible peer-reviewed studies were identified and evaluated for prevalence data, virological characteristics, genotypes, mutations, treatment outcomes, vaccination programs, and the availability of guidelines. Findings indicate intermediate-to-high HBV and HIV-HBV disease burden, substantial occult HBV infection, and gaps in diagnostic and preventive practices. The lack of routine screening, deficient infant birth-dose and adult vaccination, and established treatment pathways likely increase the risk of HBV-associated morbidity and mortality. Strengthened public health interventions, including expanded testing, enhanced vaccination coverage, and prevention of mother-to-child transmission strategies, are recommended to improve disease control and clinical outcomes in Botswana. Full article
(This article belongs to the Special Issue HIV and Viral Hepatitis Co-Infection)
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