The present and future of HIV and viral hepatitis co-infection

HIV and hepatitis virus co-infection remains a major global health challenge, driven by shared transmission routes, populations with overlapping modes of acquisition, and potentially compounded disease progression. Co-infections of HIV and hepatitis B virus (HBV) and hepatitis C virus (HCV) remain prevalent, particularly among people who live in endemic areas, key populations, people who inject drugs, men who have sex with men, and migrants from endemic regions. Antiretroviral therapy is shifting towards regimens without HBV activity, increasing the risk for HBV infection or reactivation in some individuals. Although direct-acting antivirals have reduced active HCV infection considerably in many high-income settings, residual disease burden, reinfections, and inequitable access to treatment persist. Hepatitis delta virus continues to represent a severe but underdiagnosed co-infection among individuals with HIV-HBV co-infection, with insufficient global surveillance data. Acute hepatitis A and E increasingly affect people with HIV, presenting both as outbreak-related and sporadic cases, particularly in the context of suboptimal vaccination coverage. Contemporary management emphasises systematic screening, vaccination, integrated antiviral strategies, and public health interventions to reduce liver-related morbidity and mortality in people with HIV.