Stronger protections are needed to prevent people with HIV from also becoming infected with hepatitis, researchers argue in a new study led by Michigan State University.

Behaviors that put people at higher risk of contracting HIV – sharing needles, having unprotected sex or getting blood transfusions, for instance – also raise their risk of getting hepatitis B or C, diseases that attack the liver and, if untreated, can be deadly.

The study, which included all registered cases of HIV in Michigan, found about four percent of HIV-positive people also had hepatitis. That’s less than some previous studies have found elsewhere, but it still represents a significant public health concern, said Zahid Butt, who led the research as a doctoral student in MSU’s Department of Epidemiology and Biostatistics.

“Ultimately, because of the fact that they’re suffering from two diseases, they’re more likely to die than if they only have one,” said Butt, who now runs the epidemiology division of a public health institute in Islamabad, Pakistan.

For example, having HIV more than triples the risk of liver disease, liver failure and liver-related death among individuals who also have hepatitis C, according to the Centers for Disease Control and Prevention.

The researchers found the highest rate of co-infection among males, particularly those who marked their race as “other,” which included anything other than white, black or Hispanic. Butt said that was surprising, since previous studies have found African American men were at highest risk for co-infection.

“It could be that we’re getting a cohort of people who were not vaccinated in childhood because they’re coming from countries that don’t require vaccination,” he said. “It also may be that some marginalized groups might not get vaccinated because they don’t trust the health care system.”

Butt said all states should require children to be vaccinated against hepatitis B when they go to school, as most states already do (there is no hepatitis C vaccine). He also said HIV-positive people should protect themselves from hepatitis B by getting vaccinated.

Published in the journal Epidemiology and Infection, the study also found that people who had received transfusions or other blood products were at the highest risk for co-infection. Butt said that raises concerns about whether current safeguards are sufficient to protect people who need transfusions.

“There’s a real need for proper screening of blood products,” he said. “Even with the screening process we have in place, there was a high risk of infection through blood products. We still have a four percent co-infection prevalence, which shouldn’t be the case.”

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