References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Hepatitis B (HBV) and HIV share transmission routes, so co-infection is common. Around 5-10% of people with HIV in the UK also have hepatitis B. Co-infection makes liver disease progress faster and requires careful coordination of treatment, because some HIV drugs also treat hepatitis B — and stopping them can trigger a dangerous hepatitis B flare.
Here’s what you need to know about managing both conditions together.
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How Hepatitis B Spreads
Like HIV, hepatitis B is transmitted through:
- Unprotected sex
- Sharing injecting equipment
- Mother to child during birth
- Blood-to-blood contact
Hepatitis B is more infectious than HIV. Everyone diagnosed with HIV is tested for hepatitis B at their first clinic appointment.
Why Co-infection Matters
| Impact | Detail |
|---|---|
| Faster liver damage | HIV speeds up hepatitis B progression to cirrhosis and liver cancer |
| Higher hepatitis B viral load | HIV weakens immune control of hepatitis B |
| Treatment overlap | Tenofovir and emtricitabine/lamivudine treat both viruses |
| Flare risk | Stopping hepatitis B-active drugs can cause severe liver inflammation |
| Liver cancer risk | Co-infected people need regular liver cancer screening |
Treatment
The good news is that several HIV drugs also treat hepatitis B:
- Tenofovir (both TDF and TAF forms) — the backbone of co-infection treatment
- Emtricitabine and lamivudine — active against hepatitis B
Your HIV regimen should include tenofovir (plus emtricitabine or lamivudine) to treat both infections simultaneously. This is why many first-line HIV regimens (Biktarvy, Symtuza) are suitable for co-infection.
Dovato (dolutegravir + lamivudine) is not recommended for hepatitis B co-infection because lamivudine alone is insufficient and can cause hepatitis B resistance.
Critical Safety Rule
Never stop tenofovir, emtricitabine or lamivudine without discussing with your HIV team if you have hepatitis B. Stopping these drugs can trigger a hepatitis B flare — a sudden, severe worsening of liver inflammation that can be life-threatening.
Monitoring
- Regular liver blood tests (ALT, AST)
- Hepatitis B viral load monitoring
- Liver cancer screening (ultrasound every 6 months if cirrhotic)
- FibroScan or similar to assess liver scarring
Vaccination
If you are HIV-positive and hepatitis B negative, vaccination is strongly recommended. People with HIV may need a higher dose or more doses to achieve immunity. Your HIV clinic will check your antibody response after vaccination.
Read more: Hepatitis B treatment with HIV | What is HIV? | HIV and the immune system
Frequently Asked Questions
Can hepatitis B be cured?
Functional cure (surface antigen loss) is possible but uncommon. Most people with chronic hepatitis B need lifelong treatment to suppress the virus, similar to HIV.
Does my HIV regimen treat hepatitis B automatically?
If your regimen contains tenofovir, yes. Your HIV team will ensure your combination treats both infections.
What happens if I stop my HIV medication?
If your HIV medication includes drugs active against hepatitis B, stopping can cause a severe hepatitis B flare. Never stop without medical guidance.
Related reading
- Blood Test for Syphilis, Hepatitis B and Hepatitis C
- Can You Die From Hepatitis B?
- What Is Hepatitis A?
- What Is Hepatitis B?
- Hepatitis B Core Antibody Test Explained
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
