What are opportunistic infections (OIs) in HIV?

Having HIV weakens your body's immune system. It destroys the white blood cells that fight infection. This puts you at risk for opportunistic infections (OIs). OIs are serious infections that take advantage of your weak immune system. These infections are less common and less severe in healthy people.

People who have AIDS, the most severe stage of HIV infection, have badly damaged immune systems. This puts them especially at risk for OIs. Getting certain OIs is one of the ways that people can get diagnosed with AIDS.

OIs are becoming less common in people with HIV because of effective HIV medicines. But some people with HIV still develop OIs for different reasons:

• They may not know they have HIV, so they aren't getting treatment for it
• They know that they have HIV but are not taking treatment
• Their HIV treatment may not be working properly

What are the different types of opportunistic infections (OIs)?

There are many types of OIs:

• Bacterial infections, including tuberculosis, , and (MAC)
• Viral infections, such as cytomegalovirus (CMV) and herpes simplex virus 1 (HSV-1)
• Fungal infections, like yeast infections, (PCP), and histoplasmosis
• Parasitic infections, such as cryptosporidiosis and toxoplasmosis

Having HIV can make infections harder to treat. People with HIV are also more likely to have complications from common illnesses such as the flu.

What are the treatments for opportunistic infections (OIs)?

If you develop an OI, there are treatments available such as antiviral, antibiotic, and antifungal drugs. The type of medicine your health care provider prescribes will depend on which OI you have.

After the OI has been successfully treated, you may still need to take the same medicine or another medicine to prevent the OI from coming back.

Can opportunistic infections (OIs) be prevented?

The best way to prevent OIs infections is by taking your HIV medicines. Other steps you can take to help prevent OIs include:

• Avoiding exposure to contaminated food and water:
  • Don't undercooked eggs, unpasteurized dairy products or fruit juices, or raw seed sprouts
  • Don't drink water directly from a lake or river
• Talking to your provider about medicines and vaccines that prevent certain OIs
• Preventing exposure to other sexually transmitted diseases by using condoms every time you have sex
• Washing your hands thoroughly with warm, soapy water after any contact with human or animal feces (poop)
• Not sharing needles, syringes, or other drug injection equipment

Do people infected with human immunodeficiency virus (HIV) have an increased risk of cancer?

Yes. People infected with HIV have a substantially higher risk of some types of cancer compared with uninfected people of the same age. The general term for these cancers is "HIV-associated cancers." Three of these cancers are known as "acquired immunodeficiency syndrome (AIDs)-defining cancers" or "AIDS-defining malignancies": Kaposi sarcoma, aggressive B-cell non-Hodgkin lymphoma, and cervical cancer. A diagnosis of any of these cancers in someone infected with HIV confirms a diagnosis of AIDS.

Compared with the general population, people infected with HIV are currently about 500 times more likely to be diagnosed with Kaposi sarcoma, 12 times more likely to be diagnosed with non-Hodgkin lymphoma, and, among women, 3 times more likely to be diagnosed with cervical cancer.

In addition, people infected with HIV are at higher risk of several other types of cancer (collectively called "non–AIDS-defining cancers"). These other malignancies include cancers of the anus, liver, oral cavity/pharynx, and lung, and Hodgkin lymphoma.

People infected with HIV are 19 times more likely to be diagnosed with anal cancer, 3 times as likely to be diagnosed with liver cancer, 2 times as likely to be diagnosed with lung cancer, about 2 times as likely to be diagnosed with oral cavity/pharynx cancer, and about 8 times more likely to be diagnosed with Hodgkin lymphoma compared with the general population.

In addition to being linked to an increased risk of cancer, HIV infection is associated with an increased risk of dying from cancer. HIV-infected people with a range of cancer types are more likely to die of their cancer than HIV-uninfected people with these cancers.

Why might people infected with HIV have a higher risk of some types of cancer?

Infection with HIV weakens the immune system and reduces the body's ability to fight viral infections that may lead to cancer. The viruses that are most likely to cause cancer in people with HIV are:

• Kaposi sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV-8), which causes Kaposi sarcoma and some subtypes of lymphoma
• Epstein-Barr virus (EBV), which causes some subtypes of non-Hodgkin and Hodgkin lymphoma
• Human papillomaviruses (HPV), high-risk types of which cause cervical cancer, most anal cancers, and oropharyngeal, penile, vaginal, and vulvar cancer
• Hepatitis B virus (HBV) and hepatitis C virus (HCV), which both cause liver cancer

HIV-infected persons are more likely to be infected with these viruses than people in the general population.

In addition, the prevalence of some traditional risk factors for cancer, especially smoking (a known cause of lung and other cancers) and heavy alcohol use (which can increase the risk of liver cancer), is higher among people infected with HIV. Also, because people infected with HIV have compromised immune systems, both immunosuppression and inflammation may have direct or indirect roles in the development of some cancers that are elevated in people infected with HIV.

The poorer cancer survival of HIV-infected people may result, at least in part, from the weakened immune system in such individuals. The increased risk of death could also result from the cancer being more advanced at diagnosis, delays in cancer treatment, or poorer access to appropriate cancer treatment.

Has the introduction of antiretroviral therapy changed the cancer risk of people infected with HIV?

The introduction of highly active antiretroviral therapy (HAART), also called combination antiretroviral therapy (cART), starting in the mid-1990s greatly reduced the incidence of certain cancers in HIV-infected patients, especially Kaposi sarcoma and non-Hodgkin lymphoma. The likely explanation for this reduced incidence is that cART lowers the amount of HIV circulating in the blood, thereby allowing partial restoration of immune system function to fight the viruses that cause many of these cancers.

Although the risk of these AIDS-defining cancers among people infected with HIV is lower than in the past, it is still much higher than among people in the general population. This persistently high risk may reflect the fact that cART does not completely restore immune system functioning. Also, many people infected with HIV are not aware they are infected, have had difficulty in accessing medical care, or for other reasons are not receiving adequate antiretroviral therapy.

The introduction of cART has not reduced the incidence of all HIV-related cancers, and in fact there has been an increase in non–AIDS-defining cancers. For example, the incidence of liver and anal cancer may be increasing among HIV-infected individuals.

An important factor contributing to the increase in non–AIDS-defining cancers is that as cART has reduced the number of deaths from AIDS, the HIV-infected population has grown in size and become older. The fastest growing proportion of HIV-infected individuals is the over-40 age group. These individuals are now developing cancers common in older age and also have an increased cumulative risk of developing HIV-associated cancers.

What can people infected with HIV do to reduce their risk of cancer or to find cancer early?

Taking cART as indicated based on current HIV treatment guidelines lowers the risk of Kaposi sarcoma and non-Hodgkin lymphoma and increases overall survival.

The risk of lung, oral, and other cancers can be reduced by quitting smoking. Because HIV-infected people have a higher risk of lung cancer, it is especially important that they do not smoke.

The higher incidence of liver cancer among HIV-infected people appears to be related to more frequent infection with hepatitis virus (particularly HCV in the United States) than among HIV-uninfected people. Therefore, HIV-infected individuals should know their hepatitis status.

In addition, if HIV-infected people currently have viral hepatitis, they should discuss with their health care provider whether antiviral treatment is an option for them. Some drugs may be used for both HBV-suppressing therapy and cART.

Because HIV-infected women have a higher risk of cervical cancer, it is important that they be screened regularly for this disease. In addition, the Centers for Disease Control and Prevention (CDC) recommends vaccination against human papillomavirus (HPV) for women and men with HIV infection up to age 26 years. Cervical cancer screening guidelines that incorporate results of a Pap test and an HPV DNA test are evolving, and women should discuss screening options with their healthcare provider.

Some researchers recommend anal Pap test screening to detect and treat early lesions before they progress to anal cancer. However, it is not clear if this type of screening benefits all HIV-infected people or if treating such lesions prevents anal cancer. These questions are being addressed in an NCI-funded trial called the Anal Cancer/HSIL Outcomes Research (ANCHOR) Study. This study is currently enrolling men and women with HIV to undergo anal Pap testing and then be randomly assigned to receive either treatment or observation (no treatment). The goal is to determine whether treatment of anal lesions prevents anal cancer in HIV-infected people with anal lesions.

KSHV is secreted in saliva, and transmission of this virus may occur through deep kissing, through the use of saliva as a lubricant in sex, or through oral–anal sex. Reducing contact through these routes may reduce the chance of being infected with KSHV.

People with HIV may have concerns and questions about COVID-19, including the risk of serious illness and vaccine safety. CDC will continue to provide updated information as it becomes available.

Are people with HIV at higher risk for serious illness from COVID-19 than other people?

We are still learning about COVID-19 and how it affects people with HIV. Nearly half of people in the United States with diagnosed HIV are ages 50 and older. People with HIV also have higher rates of certain underlying health conditions. Older age and underlying health conditions can make people more likely to become seriously ill if they get COVID-19. 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, and those who live with or visit them, should take precautions (including getting vaccinated and wearing a well-fitting mask) to protect themselves and others from COVID-19.

Do COVID-19 treatments interact with medicine to treat or prevent HIV?

Some COVID-19 treatments can interact with antiretroviral therapy (ART) used to treat HIV. If you have HIV, let your health care provider know before starting COVID-19 treatment. There are no known interactions between HIV treatment and the medicine used to prevent COVID-19 (Evusheld).

For people without HIV, there is no evidence that currently available medicine used to treat or prevent COVID-19 will interact with pre-exposure prophylaxis (PrEP) to prevent HIV.

If you have possible symptoms of COVID-19, have had a positive test, or been exposed to the virus that causes COVID-19, talk to your health care provider to see if you’re eligible for COVID-19 treatment or preventive medicine.

Do COVID-19 vaccines increase the risk of someone getting HIV?

No. There is no association between COVID-19 vaccines and risk for HIV infection. COVID-19 vaccines improve the immune system’s ability to prevent COVID-19 and protect vaccinated people from the more severe complications of COVID-19. 

Are COVID-19 vaccines safe for people with HIV?

Yes. COVID-19 vaccines are safe for people with HIV. COVID-19 vaccines meet the Food and Drug Administration’s rigorous scientific standards for safety, effectiveness, and manufacturing quality and people with HIV were included in vaccine clinical trials.

Authorized or approved COVID-19 vaccines will continue to undergo the most intensive safety monitoring. This includes using established and new safety monitoring systems to make sure that COVID-19 vaccines are safe.

How many doses of the COVID-19 vaccine do people with HIV need to get?

COVID-19 Vaccine Primary Series

COVID-19 vaccines are recommended for everyone who is eligible. The number of vaccine doses you need depends on the type of vaccine you receive.

Additional Primary Shot

After completing the COVID-19 vaccine primary series, some people who have advanced HIV (including an AIDS diagnosis) or who have HIV and are not taking HIV treatment should get an additional primary shot. The additional primary shot is intended to improve a person’s immune response to their two-dose COVID-19 vaccine primary series. People who are eligible for an additional primary shot should receive this dose before they get a booster shot. Talk to your health care provider to determine if getting an additional primary shot is right for you.

CDC does not recommend an additional primary shot of the COVID-19 vaccine for people with HIV who are virally suppressed or who do not have advanced HIV.

Booster Shot

CDC recommends that everyone, including people with HIV, get a booster shot when they are eligible. Learn more about who should get a booster, when to get a booster, and which booster you should get.

Will COVID-19 vaccines interfere with medicine to prevent or treat HIV?

There is no evidence that COVID-19 vaccines interfere with pre-exposure prophylaxis (PrEP) to prevent HIV or with antiretroviral therapy (ART) to treat HIV. Learn more about the different COVID-19 vaccines.

What can people with HIV do to protect themselves from COVID-19?

People with HIV can protect themselves from COVID-19 by following CDC’s COVID-19 prevention recommendations.

If you have HIV and are taking your HIV medicine as prescribed, it is important to continue your treatment and follow your health care provider’s advice. This is the best way to keep your immune system healthy. People with HIV should also continue to maintain a healthy lifestyle.

Here are more steps that people with HIV can take:

• Make sure you have at least a 30-day (or longer) supply of your HIV medicine and any other medicines or medical supplies you need for managing HIV. Ask your health care provider about getting your medicine by mail.
• Talk to your health care provider and make sure all your vaccinations are up to date, including vaccinations against seasonal influenza (flu) and bacterial pneumonia. These vaccine-preventable diseases affect people with HIV more than others.
• When possible, keep your medical appointments. Check with your health care provider about safety precautions for office visits and ask about telemedicine or remote clinical care options.
• People with HIV can sometimes be more likely than others to need extra help from friends, family, neighbors, community health workers, and others. If you become sick, make sure you stay in touch by phone or email with people who can help you.

What should I do if I think I might have COVID-19?

Call your health care provider if you develop symptoms that could be consistent with COVID-19.

It’s important to continue taking your HIV medicine as prescribed. This will help keep your immune system healthy.

Learn more about COVID-19 and what to do if you get sick.

Can HIV medicine (ART) be used to treat COVID-19?

Currently, treatment for COVID-19 is limited. There are no HIV medicines approved to treat COVID-19. People with HIV should not switch their HIV medicine in an attempt to prevent or treat COVID-19.

Some clinical trials are looking at whether HIV medicines can treat COVID-19. Other trials are looking at the effectiveness of different drugs to treat COVID-19 in people with HIV. They are also looking to better understand how people with HIV manage COVID-19.

Key Points

• In people with HIV, good nutrition supports overall health and helps maintain the immune system. Good nutrition also helps people with HIV maintain a healthy weight and absorb HIV medicines.
• Food and water can be contaminated with germs that cause illnesses (called foodborne illnesses or food poisoning).
• Because HIV damages the immune system, foodborne illnesses are likely to be more serious and last longer in people with HIV than in people with a healthy immune system.
• Food safety is about how to select, handle, prepare, and store food to prevent foodborne illnesses. Following food safety guidelines reduces the risk of foodborne illnesses.

Why is good nutrition important for people living with HIV?

Good nutrition is about finding and maintaining a healthy eating style. Good nutrition supports overall health and helps maintain the immune system. It also helps people with HIV maintain a healthy weight and absorb HIV medicines.

HIV attacks and destroys the immune system, which makes it harder for the body to fight off infections. People with HIV take a combination of HIV medicines (called an HIV treatment regimen) every day. The medicines prevent HIV from destroying the immune system. A healthy diet also helps strengthen the immune system and keep people with HIV healthy.

What is a healthy diet for people living with HIV?

In general, the basics of a healthy diet are the same for everyone, including people with HIV.

• Eat a variety of foods from the five food groups: fruits, vegetables, grains, protein foods, and dairy.
• Eat the right amount of food to maintain a healthy weight.
• Choose foods low in saturated fat, sodium (salt), and added sugars.

Can HIV or HIV medicines cause nutrition-related problems?

HIV and HIV medicines can sometimes cause nutrition-related problems. For example, some HIV-related infections can make it hard to eat or swallow. Side effects from HIV medicines, such as loss of appetite, nausea, or diarrhea, can make it hard to stick to an HIV regimen. If you have HIV and are having a nutrition-related problem, talk to your health care provider.

To avoid nutrition-related problems, people with HIV must also pay attention to food safety.

What is food safety?

Food and water can be contaminated with germs that cause illnesses (called foodborne illnesses or food poisoning). Food safety is about how to select, handle, prepare, and store food to prevent foodborne illnesses.

Why is food safety important for people living with HIV?

Because HIV damages the immune system, foodborne illnesses are likely to be more serious and last longer in people with HIV than in people with a healthy immune system. Following food safety guidelines reduces the risk of foodborne illnesses.

What steps can people with HIV take to prevent foodborne illnesses?

If you have HIV, follow these food safety guidelines to reduce your risk of foodborne illnesses:

Do not eat or drink the following foods:

• Raw eggs or foods that contain raw eggs, for example, homemade cookie dough
• Raw or undercooked poultry, meat, and seafood
• Unpasteurized milk or dairy products and fruit juices

Follow the four basic steps to food safety: clean, separate, cook, and chill.

• Clean: Wash your hands, cooking utensils, and countertops often when preparing foods.
• Separate: Separate foods to prevent the spread of any germs from one food to another. For example, keep raw meat, poultry, seafood, and eggs separate from foods that are ready to eat, including fruits, vegetables, and breads.
• Cook: Use a food thermometer to make sure that foods are cooked to safe temperatures.
• Chill: Refrigerate or freeze meat, poultry, eggs, seafood, or other foods that are likely to spoil within 2 hours of cooking or purchasing.

As a person living with HIV/AIDS, you have many opportunities for a healthy and full life. You may also have some health challenges. One of those challenges is avoiding infections.

Many fungal infections are called opportunistic infections, which means that they usually affect people with weak immune systems. Because HIV weakens the immune system, you have a greater chance of getting some types of fungal infections, like cryptococcosis, coccidioidomycosis, histoplasmosis, and pneumocystis pneumonia (PCP).

What you need to know about fungal infections

Your CD4 count is important. You’re at greatest risk for fungal infection when your CD4 count is less than 200. Keeping your CD4 count above 200 may help you avoid serious illness.

Anti-retroviral therapy (ART) is important. Starting ART helps slow the progress of HIV and can reduce your chances of getting a fungal infection.

Fungal infections can range from mild to life-threatening. Some fungal infections are mild skin rashes, but others can be deadly, like fungal meningitis. Because of this, it’s important to seek treatment as soon as possible to try to avoid serious infection.

Fungal infections can look like bacterial or viral infections. If you’re taking medicine to fight an infection and you aren’t getting better, ask your doctor about testing you for a fungal infection.

Where you live (geography) matters. Some disease-causing fungi are more common in certain parts of the world. If you have HIV/AIDS and live in or visit these areas, you’re more likely to get these infections than the general population.

Your activities matter. Disease-causing fungi can be found in air, dust, and soil, especially soil that contains bird or bat droppings. Doing activities that disturb the soil, like gardening, cleaning chicken coops, construction, demolition, and visiting caves can cause you to inhale more fungi and increases your chance of infection.

Some fungal infections can interfere with taking your medications. Thrush, an infection in the mouth and throat, is sometimes seen among people living with HIV/AIDS. This infection is not usually life-threatening, but can be painful, make it difficult to eat, or interfere with taking your medications. Your nutrition is an important part of staying healthy, so it’s important to seek care for this infection.

Preventing fungal infections in people living with HIV/AIDS

Fungi are difficult to avoid because they are a natural part of the environment. Fungi live outdoors in soil, on plants, trees, and other vegetation. They are also on many indoor surfaces and on your skin. However, there may be some ways for you to lower your chances of getting a serious fungal infection.

Learn about fungal infections. There are different types of fungal infections. Learning about them can help you and your healthcare provider recognize the symptoms early, which may prevent serious illness.

Find out about your risk. The danger of getting a fungal infection can change depending on your location and your CD4 count. Learning what things can put you at risk may prevent serious illness.

Get additional medical care if necessary. Fungal infections often resemble other illnesses. Visiting your healthcare provider may help with faster diagnosis and may prevent serious illness.

Antifungal medication. Your healthcare provider may prescribe medication to prevent fungal infections. For example, they may recommend medication (TMP-SMX, also called Bactrim, Septra, or Cotrim) to prevent a type of fungal pneumonia called Pneumocystis jirovecii pneumonia (PCP).

Protect yourself from the environment. There may be some ways to lower your chances of getting a serious fungal infection by trying to avoid disease-causing fungi in the environment. It’s important to note that although these actions are recommended, they have not been proven to prevent fungal infections.

• Try to avoid areas with a lot of dust like construction or excavation sites.
• Stay inside during dust storms.
• Stay away from areas with bird and bat droppings. This includes places like chicken coops and caves.
• Wear gloves when handling materials such as soil, moss, or manure.
• Wear shoes, long pants, and a long-sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas.

Testing for early fungal infection. In areas of the world with high rates of HIV/AIDS and where cryptococcosis is common, high-risk HIV patients can be tested for this infection before symptoms appear. If the test detects early cryptococcal infection, treatment can prevent it from becoming deadly.

Key Points

• Hepatitis B is a liver infection caused by the hepatitis B virus (HBV).
• HBV is spread through contact with the blood, semen, or other body fluid of a person who has HBV. Among adults in the United States, HBV is spread mainly through sexual contact.
• According to the Centers for Disease Control and Prevention (CDC), approximately 10% of people with HIV in the United States also have HBV. Infection with both HIV and HBV is called HIV/HBV coinfection.
• People with HIV/HBV coinfection should be treated for both infections.

What is hepatitis B?

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV) . The abbreviation HBV can stand for either the virus or the infection it causes.

HBV can be a short-term (acute) or a long-term (chronic) illness:

• Acute HBV occurs within 6 months after a person is exposed to HBV. In some people, acute HBV can lead to chronic HBV.
• Chronic HBV is a lifelong disease. Without treatment, chronic HBV can cause liver cancer or liver damage that leads to liver failure.

HBV is a contagious infection that can spread from person to person.

How does HBV spread from person to person?

HBV is spread through contact with the blood, semen, or other body fluid of a person who has HBV. Among adults in the United States, HBV is spread mainly through sexual contact.

HBV can also spread from person to person in the following ways:

• By sharing needles or other injection drug equipment (works) with someone who has HBV
• By sharing razors, toothbrushes, or similar personal items with someone who has HBV
• From contact with the blood or open sores of a person who has HBV
• From an accidental prick or cut from an HBV-contaminated needle or other sharp object
• From a mother who has HBV to her child during childbirth

What is the connection between HIV and HBV?

Both HIV and HBV spread from person to person in semen, blood, or other body fluids. For this reason, the main risk factors for HIV and HBV are the same: having sex without a condom and injection drug use.

According to the Centers for Disease Control and Prevention (CDC), approximately 10% of people with HIV in the United States also have HBV. Infection with both HIV and HBV is called HIV/HBV coinfection.

Chronic HBV advances faster to cirrhosis, end-stage liver disease, and liver cancer in people with HIV/HBV coinfection than in people with only HBV infection. But chronic HBV does not appear to cause HIV to advance faster in people with HIV/HBV coinfection.

Can HBV infection be prevented?

Yes. The best way to prevent HBV is to get the hepatitis B vaccine.

CDC recommends that people with HIV and people who are at risk for HIV get the HBV vaccine (or the combined hepatitis A virus/HBV vaccine). The housemates and sexual partners of people with HBV should get the HBV vaccine, too.

People, including people with HIV, can also take the following steps to reduce their risk of HBV infection:

• Use condoms during sex to reduce the risk of HBV infection and infection with other sexually transmitted diseases, such as gonorrhea and syphilis.
• Do not inject drugs. But if you do, do not share needles, syringes, or other drug injection equipment.
• Do not share toothbrushes, razors, or other personal items that may come in contact with another person's blood.
• If you get a tattoo or body piercing, make sure the instruments used are sterile.

Should people with HIV get tested for HBV?

CDC recommends that all people with HIV get tested for HBV. Testing can detect HBV even when a person has no symptoms of the infection.

There are several HBV blood tests. Results of different tests show different things. For example, a positive hepatitis B surface antigen (HBsAg) test result shows that a person has acute or chronic HBV and can spread the virus to others.

What are the symptoms of HBV infection?

Some people with acute HBV do not have symptoms. But some people can have signs of HBV soon after becoming infected. Symptoms of acute HBV can include the following:

• Loss of appetite
• Tiredness
• Nausea
• Vomiting
• Fever
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellowing of the skin or the whites of the eyes)

Most people with chronic HBV do not have any symptoms and may not have symptoms for many years. Abnormal results on liver function tests may be the first sign of chronic HBV infection.

What is the treatment for HBV?

In general, HBV is treated with antiviral medicines. The medicines work to help limit damage to the liver.

People with HIV/HBV coinfection should be treated for both infections. Some HIV medicines are effective at treating both HIV and HBV.

The choice of medicines to treat HIV/HBV coinfection depends on the person. For example, some people may take HIV medicines that are also effective at treating HBV. Other people may take HIV medicines and an HBV antiviral medicine. If you have HIV/HBV coinfection, talk to your health care provider about the best medicines for you.

Key Points

• Hepatitis C is a liver infection caused by the hepatitis C virus (HCV).
• HCV is spread mainly through contact with the blood of a person who has HCV. In the United States, HCV is spread mainly by sharing needles or other injection drug equipment (works) with someone who has HCV.
• According to the Centers for Disease Control and Prevention (CDC), approximately 21% of people with HIV in the United States also have HCV. Infection with both HIV and HCV is called HIV/HCV coinfection.
• People with both HIV and HCV may be treated for both infections. Health care providers prescribe HIV and HCV medicines carefully to avoid drug-drug interactions and closely monitor those taking the medicines for any side effects.

What is hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). The abbreviation HCV can stand for either the virus or the infection it causes.

HCV can be either a short-term (acute) or a long-term (chronic) illness:

• Acute HCV occurs within 6 months after exposure. In most people, acute HCV becomes chronic HCV.
• Chronic HCV can last a lifetime. Without treatment, chronic HCV can cause liver cancer or severe liver damage that can lead to liver failure.
• HCV is a contagious infection that can spread from person to person.

How does HCV spread from person to person?

HCV is spread mainly through contact with the blood of a person who has HCV. In the United States, HCV is spread mainly by sharing needles or other injection drug equipment (works) with someone who has HCV. HCV can also be spread through sexual contact. While the risk of transmission through sexual contact is low, the risk is increased in people with HIV.

What is the connection between HIV and HCV?

Because both HIV and HCV can spread in blood, a major risk factor for both HIV and HCV infection is injection drug use. Sharing needles or other drug injection equipment increases the risk of contact with HIV- or HCV-infected blood.

According to the Centers for Disease Control and Prevention (CDC), approximately 21% of people with HIV in the United States also have HCV. Infection with both HIV and HCV is called HIV/HCV coinfection.

In people with HIV/HCV coinfection, HIV may cause chronic HCV to advance faster. Whether HCV causes HIV to advance faster is unclear.

Can HCV infection be prevented?

The best protection against HCV is to never inject drugs. If you do inject drugs, always use new, sterile needles, and do not reuse or share needles, syringes, or other injection drug equipment.

People, including people with HIV, can also take the following steps to reduce their risk of HCV infection:

• Do not share toothbrushes, razors, or other personal items that may come in contact with another person’s blood.
• If you get a tattoo or body piercing, make sure the instruments used are sterile.
• Use condoms during sex. The risk of HCV infection through sexual contact is low, but the risk increases in people with HIV. Condoms also reduce the risk of HIV transmission and infection with other sexually transmitted diseases, such as gonorrhea and syphilis.

Should people with HIV get tested for HCV?

Every person who has HIV should get tested for HCV. Usually, a person will first get an HCV antibody test. This test checks for HCV antibodies in the blood. HCV antibodies are disease-fighting proteins that the body produces in response to HCV infection.

A positive result on an HCV antibody test means that the person has been exposed to HCV at some point in their life. However, a positive antibody test does not necessarily mean the person has HCV. For this reason, a positive result on an HCV antibody test must be confirmed by a second test. This follow-up test checks to see if HCV is present in the person’s blood. A positive result on this test confirms that a person has HCV.

What are the symptoms of HCV infection?

Most people with acute HCV do not have symptoms. But some people can show signs of HCV soon after becoming infected. Symptoms of acute HCV can include the following:

• Fever
• Tiredness
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark-colored urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellowing of the skin or the whites of the eyes)

Most people with chronic HCV do not have any symptoms. Chronic HCV is often discovered based on results from routine liver function tests.

What is the treatment for HCV?

HCV is treated with antiviral medicines. Many newer HCV medicines are more effective and have fewer side effects than older medicines. The newer medicines can cure HCV in most people.

People with HIV/HCV coinfection may be treated for both infections. However, when to start each treatment and what medicines to take depends on the person. For example, some HIV and HCV medicines cannot be safely used together because of drug-drug interactions.

Health care providers prescribe HIV and HCV medicines carefully to avoid drug-drug interactions and closely monitor those taking the medicines for any side effects.

If you have HIV/HCV coinfection, talk to your health care provider about the best medicines for you.

Current data suggest that about 40% of people diagnosed with mpox in the United States also had HIV (human immunodeficiency virus). CDC doesn’t know if having HIV increases the likelihood of getting sick with mpox if exposed to the virus. However, we do know that people with severe immunocompromise (like advanced HIV) are at increased risk of severe mpox, or even death, if they become infected.

If you have HIV, you should follow the same recommendations as everyone else to protect yourself from mpox. Taking your HIV medication as prescribed and keeping an undetectable viral load are the best things you can do to stay healthy and doing so also prevents you from sexually transmitting HIV to your HIV-negative partner. Learn more about how to live well with HIV.

Mpox Vaccines and People with HIV

CDC recommends vaccination for people who have been exposed to mpox virus and people who may be more likely to get mpox. Learn more about who should get vaccinated.

There are currently two vaccines (JYNNEOS and ACAM2000) that can be used to prevent mpox.

• JYNNEOS vaccine is authorized for the prevention of mpox and is considered safe for people with HIV. This is the vaccine currently being offered in the United States.
• CDC does not recommend the ACAM2000 vaccine for people with HIV due to the increased risk of serious side effects.

Talk to your health care provider to see if you should get vaccinated against mpox.

Getting Mpox When You Have HIV

• Limited data suggest that people with HIV, particularly people with low CD4 counts (350 cells/ml) or who are not virally suppressed, are more likely to be hospitalized if they get mpox than people without HIV.
• Medicines used to treat smallpox are considered 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 what we know, mpox treatments have few interactions with HIV medicines. If you have HIV, let your health care provider know before starting mpox treatment.

Mpox and HIV PrEP and HIV PEP

HIV pre-exposure prophylaxis (PrEP) and HIV post-exposure prophylaxis (PEP) are still effective for preventing HIV even if you have received the mpox vaccine, have mpox, or are taking mpox treatment.  If you have been prescribed HIV PrEP or HIV PEP by your health care provider, you should continue taking your medicine as prescribed.

You may have heard of mpox PrEP and PEP. This can be confusing because we use the terms PrEP and PEP in HIV prevention as well. Here’s how they are different:

• HIV PrEP (pre-exposure prophylaxis) is medicine that reduces your chances of getting HIV.
• When you get the mpox vaccine to reduce your chances of getting mpox in the future, this is sometimes called mpox vaccine PrEP.
• HIV PEP (post-exposure prophylaxis) is medicine that can reduce your chances of getting HIV after a possible exposure.
• When you get the mpox vaccine to reduce your chance of getting mpox because you were exposed or think you might have been exposed, this is sometimes called mpox vaccine PEP.

What is tuberculosis?

Tuberculosis (TB) is a contagious disease that can spread from person to person. TB is caused by bacteria called Mycobacterium tuberculosis. The TB bacteria spread in the air.

TB usually affects the lungs. But TB-causing bacteria can attack any part of the body, including the kidneys, spine, or brain. If not treated, TB can cause death.

How does TB spread from person to person?

When a person with TB disease of the lungs coughs or speaks, droplets of TB bacteria spread through the air. People nearby who breathe in the TB bacteria can get TB.

Once in the body, TB can be inactive or active. When the TB bacterium is inactive, this is called latent TB infection. When the TB bacterium is active, this is called TB disease. The image below shows the difference between latent TB infection and TB disease.

What is the connection between HIV and TB?

TB is an opportunistic infection (OI). OIs are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. HIV weakens the immune system, increasing the risk of TB in people with HIV.

Infection with both HIV and TB is called HIV/TB coinfection. Untreated latent TB infection is more likely to advance to TB disease in people with HIV than in people without HIV. In people with HIV, TB disease is considered an AIDS-defining condition. AIDS-defining conditions are infections and cancers that are life-threatening in people with HIV.

Treatment with HIV medicines is called antiretroviral therapy (ART). HIV medicines protect the immune system and prevent HIV from advancing to acquired immunodeficiency syndrome (AIDS). In people with HIV and latent TB infection, treatment with HIV and TB medicines reduces the chances that latent TB infection will advance to TB disease.

How common is HIV/TB coinfection?

Worldwide, TB disease is one of the leading causes of death among people with HIV. In the United States, where HIV medicines are widely used, fewer people with HIV get TB than in many other countries. But TB still affects many people with HIV in the United States, especially those born outside the United States.

Should people with HIV get tested for TB?

Yes, all people with HIV should get tested for TB infection, preferably at the time of HIV diagnosis. If test results show that a person has latent TB, additional testing is needed. More testing will determine whether the person has TB disease.

What are the symptoms of TB?

People with latent TB don’t have any signs of the disease. But if latent TB advances to TB disease, there will usually be signs of the disease. Common symptoms of TB disease include:

• A persistent cough that may bring up blood or sputum
• Chest pain
• Fatigue
• Loss of appetite
• Weight loss
• Fever
• Night sweats

What is the treatment for TB?

In general, TB treatment is the same for people with HIV and people without HIV. TB medicines are used to prevent latent TB from advancing to TB disease and to treat TB disease. The choice of TB medicines and the length of treatment depend on whether a person has latent TB or TB disease.

People with HIV/TB coinfection should be treated for both diseases; however, when to start treatment and what medicines to take depends on a person’s individual circumstances. Taking certain HIV and TB medicines at the same time can increase the risk of drug-drug interactions and side effects. People being treated for HIV/TB coinfection are carefully monitored by their health care providers.

If you have HIV/TB coinfection, talk to your health care provider about a treatment plan that works for you.

Key Points

• Sexually transmitted diseases (STDs), also called sexually transmitted infections (STIs), are infections that spread from person to person through sexual activity, including anal, vaginal, or oral sex.
• Many health care providers use the term “infection” instead of “disease”, because a person with an infection may have no symptoms but still require treatment. When untreated, an STI can become a disease.
• HIV is a sexually transmitted infection, but it can progress to a disease called acquired immunodeficiency syndrome (AIDS) when HIV infection is untreated. Other examples of STDs are chlamydia, gonorrhea, human papillomavirus (HPV) infection, and syphilis.
• Having an STD can make it easier to get HIV. For example, an STD can cause a sore or a break in the skin, which can make it easier for HIV to enter the body. Having HIV and another STD may increase the risk of HIV transmission.
• To prevent STDs, including HIV, choose less risky sexual behaviors and use condoms correctly every time you have sex.

What is an STD?

STD stands for sexually transmitted disease, also called sexually transmitted infections (STIs). STDs are infections that spread from person to person through sexual activity, including anal, vaginal, or oral sex. STDs are caused by bacteria, parasites, and viruses.

Many health care providers use the term “infection” instead of “disease”, because a person with an infection may have no symptoms but still require treatment. When untreated, an STI can become a disease.

HIV is a sexually transmitted infection, but it can progress to a disease called acquired immunodeficiency syndrome (AIDS) when HIV infection is untreated with HIV medicines. Other examples of STDs are chlamydia, gonorrhea, human papillomavirus (HPV) infection, and syphilis.

What is the connection between HIV and other STDs?

Behaviors that put people at risk for HIV also increase their risk for other STDs. These behaviors include the following:

• Having sex without a condom.
• Having sex with many partners, especially anonymous partners.
• Having sex while using drugs or alcohol. Using drugs and alcohol can affect a person's judgement, which can lead to risky behaviors.

Having an STD can make it easier to get HIV. For example, an STD can cause a sore or a break in the skin, which can make it easier for HIV to enter the body. Having HIV and another STD may increase the risk of HIV transmission.

How can a person reduce the risk of getting an STD?

Sexual abstinence (never having vaginal, anal, or oral sex) is the only way to eliminate any chance of getting an STD. But if you are sexually active, you can take the following steps to lower your risk for STDs, including HIV.

Choose less risky sexual behaviors.

• Reduce the number of people you have sex with.
• Do not drink alcohol or use drugs before and during sex.

Use condoms correctly every time you have sex.

• Visit this website from the Centers for Disease Control and Prevention (CDC) to learn how to use condoms correctly.

How can a person with HIV prevent passing HIV to others?

Take HIV medicines daily. Treatment with HIV medicines (called antiretroviral therapy or ART) helps people with HIV live longer, healthier lives. One of the goals of ART is to reduce a person's viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partner through sex.

If your viral load is not undetectable—or does not stay undetectable—you can still protect your partner from HIV by using condoms and choosing less risky sexual behaviors. Your partner can take medicine to prevent getting HIV, which is called pre-exposure prophylaxis (PrEP). PrEP is an HIV prevention option for people who do not have HIV but who are at risk of getting HIV. PrEP involves taking a specific HIV medicine every day to reduce the risk of getting HIV through sex or injection drug use.

What are the symptoms of STDs?

Symptoms of STDs may be different depending on the STD, and not everyone will experience the same STD symptoms. Examples of possible STD symptoms include painful urination (peeing), unusual discharge from the vagina or penis, and fever.

STDs may not always cause symptoms. Even if a person has no symptoms from an STD, it is still possible to pass the STD on to other people.

Talk to your health care provider about getting tested for STDs and ask your sex partner to do the same.

What is the treatment for STDs?

STDs caused by bacteria or parasites can be cured with medicine. There is no cure for STDs caused by viruses, but treatment can relieve or eliminate symptoms and help keep the STD under control. Treatment also reduces the risk of passing on the STD to a partner. For example, although there is no cure for HIV, HIV medicines can prevent HIV from advancing to AIDS and reduce the risk of HIV transmission.

Untreated STDs may lead to serious complications. For example, untreated gonorrhea in women can cause pelvic inflammatory disease, which may lead to infertility. Without treatment, HIV can gradually destroy the immune system and advance to AIDS.

Combination antiretroviral therapy directly targets HIV and can keep levels of the virus low in the blood, resulting in far better health outcomes for those who take these lifesaving medications. However, sometimes other conditions and complications associated with HIV infection can warrant further intervention. NIAID and other institutes at NIH support research that works toward ensuring the full health of people living with HIV.

Developing Treatments for HIV Co-Infections

Many people living with HIV acquire co-infections because of vulnerabilities in their immune systems and shared risk factors for HIV and other diseases, like illicit drug use or living in an area with a high prevalence of certain pathogens. These infections can occur even in those whose HIV is well-treated and who have strong immune function relative to people living with advanced HIV, or AIDS. The most serious infections that commonly occur alongside HIV both in the United States and around the world are viral hepatitis, including hepatitis C and hepatitis B, and tuberculosis, or tuberculosis.

As many as 5 million people living with HIV around the world also have hepatitis C virus, or HCV. HCV can be a chronic condition that can lead to life-threatening liver failure and liver cancer. Traditional interferon-based treatments have not worked as well in people also living with HIV. However, researchers led by NIAID and Gilead Sciences have developed new therapies that can cure even complicated cases of HCV without serious side effects.

People living with HIV are also at an increased risk of developing tuberculosis, or TB, a disease caused by the bacteria Mycobacterium tuberculosis that usually begins in the lungs. This increased risk can be as much as 26 to 31 times higher than someone without HIV, according to the World Health Organization and appears to persist even when HIV is well-controlled with antiretroviral therapy (ART). TB is the leading cause of death among people living with HIV worldwide, with most cases occurring in developing countries. Additionally, having HIV can make TB more difficult to diagnose, and medications used to treat both infections may interact negatively. In addition to efforts to address the burden of TB disease acting alone, NIAID supports research to improve TB prevention, diagnosis, and treatment in the context of HIV infection.

To that end, in 2018, NIAID-supported researchers found that a one-month antibiotic regimen to prevent active TB was at least as safe and effective as the standard nine-month therapy for people living with HIV. The Phase 3 study, known as ACTG 5279, enrolled 3,000 individuals living with HIV around the world and randomly assigned a one-month or standard nine-month course of the anti-TB drug isoniazid. Both regimens were found to be safe and effective, though volunteers taking the one-month regimen were significantly more likely to adhere to the prescribed medication.

NIAID also supports research on opportunistic infections that can occur in cases of advanced stage HIV. When the immune system is damaged by uncontrolled HIV, fungi and other pathogens that the immune system would normally clear can lead to severe infections, like pneumocystis pneumonia or cryptococcal disease, that require immediate attention. To better address these infections when they occur, NIAID supports research to establish and refine best practices for diagnosing and treating these conditions.

Managing Non-Infectious Complications of HIV

The introduction of antiretroviral therapy (ART) and other treatment advances have transformed HIV care and the direction of treatment research over the past several decades. At the beginning of the HIV/AIDS pandemic in the 1980s, people often succumbed to opportunistic infections within years or even months of an HIV or AIDS diagnosis. Today, an individual diagnosed with HIV can expect to live to a near-normal lifespan with consistent use of effective HIV medications. As more people living with HIV progress through their fifties, sixties, and beyond, the medical community continues to learn more about how cardiovascular disease, type II diabetes, memory problems, cancer, and other conditions associated with aging may differ in people living with HIV.

Researchers have gained insight into how HIV influences individuals’ health over time through NIAID studies that follow cohorts of people living and aging with HIV, such as the START trial, the Women’s Interagency HIV Study, and the Multicenter AIDS Cohort Study. They have found that even when HIV is well-controlled with ART, immune cells undergo persistent activation that causes chronic inflammation in organs and systems throughout the body. Because inflammation is a key driver of many age-related illnesses, people with HIV are particularly prone to these conditions as they age. Also, while HIV medications ultimately preserve health and next-generation therapies have fewer side effects, long-term ART use has been linked to kidney abnormalities, osteoporosis, and other health problems.

Heart disease—the number one killer of men and women in the United States regardless of HIV status—is a particularly troubling complication of HIV infection. People living with HIV are 50 to 100 percent more likely to develop cardiovascular disease than people without HIV. This elevated risk is partially a result of chronic inflammation, which can harden blood vessels over time and increase one’s chances of experiencing heart attack and stroke. Additionally, some older HIV medications have side effects that can influence cholesterol levels, which can also contribute to cardiovascular disease.

To address the urgent need to prevent cardiovascular disease in people living with HIV, the National Heart, Lung, and Blood Institute (NHLBI) and NIAID launched the Randomized Trial to Prevent Vascular Events in HIV, or REPRIEVE, in 2015. The study has enrolled 7,500 participants between the ages of 40 and 75 in sites across the United States and abroad to determine whether a daily dose of a cholesterol-lowering statin can reduce the risk of cardiovascular disease in people living with HIV who would not normally be prescribed a statin. Researchers will also evaluate how this effect may differ for women living with HIV in an embedded study called Follow YOUR Heart.

Drugs Used to Treat Complications of HIV

*Radiesse and Sculptra are classified as a medical devices

Vaccines are especially critical for people with chronic health conditions such as HIV infection.

If you have HIV infection and your CD4 count test is 200 or greater, talk with your doctor about:

• Influenza vaccine each year to protect against seasonal flu
• Tdap vaccine to protect against whooping cough and tetanus
• Pneumococcal vaccine to protect against pneumonia and other pneumococcal diseases
• Meningococcal conjugate vaccine series which protects against meningococcal disease
• Hepatitis B vaccine series to protect against hepatitis B
• HPV vaccine series to protect against human papillomavirus if you are a man or woman up to age 26 years
• MMR vaccine to protect against measles, mumps, and rubella if you were born in 1957 or after and have not gotten this vaccine or do not have immunity to these diseases
• Varicella vaccine to protect against chickenpox if you were born in 1980 or after and have not gotten two doses of this vaccine or do not have immunity to this disease

If you have HIV infection and your CD4 count test is less than 200, talk with your doctor about:

• Influenza vaccine each year to protect against seasonal flu
• Tdap vaccine to protect against whooping cough and tetanus
• Pneumococcal vaccine to protect against pneumonia and other pneumococcal diseases
• Meningococcal conjugate vaccine series which protects against meningococcal disease
• Hepatitis B vaccine series to protect against hepatitis B
• HPV vaccine series to protect against human papillomavirus if you are a man or woman up to age 26 years