Hepatitis & PrEP

Before starting or restarting PrEP, your healthcare provider will want to know if you have hepatitis A, B, or C. You can get vaccinated to prevent two of them (A & B), and you can be treated for two of them (B & C). Hepatitis B screening is included in PrEP care. It’s important to get screened for these depending on your likelihood of exposure.

HEPATITIS A: This virus is usually transmitted by consuming food or water that’s contaminated with feces. Uncooked shellfish can also be the cause. Although it rarely causes liver failure, hepatitis A can cause severe disease. Consider getting the vaccine if you haven’t already had hepatitis A.

HEPATITIS B: This virus is usually transmitted through sex or exposure to infected blood, such as sharing needles, unsterilized tattoo tools, or during childbirth. Most people clear the infection on their own but some have lifelong (chronic) disease. Consider getting the vaccine if you haven’t already had hepatitis B.

If you have chronic hepatitis B, stopping PrEP medicines can impact it. That’s because PrEP drugs are also used to treat hepatitis B: If you stop PrEP, it can cause the virus to flare up in the liver. It is safe to take PrEP with chronic hepatitis B, but make sure your doctor monitors your health more closely if/when you decide to stop PrEP. People with chronic hepatitis B should only use daily PrEP, not 2-1-1.

HEPATITIS C: This virus is spread by blood-to-blood contact, mostly through sharing needles, unsterilized medical or tattoo equipment, and needle stick accidents. Sexual transmissions have occurred among gay men, likely due to micro-tears during anal sex. Emerging data suggest that PrEP users may be at higher risk for contracting hepatitis C through sexual transmission. Hepatitis C testing is recommended when starting PrEP, and your provider may suggest regular testing.

There is no vaccine for hepatitis C, but several different treatments can cure it. Some hepatitis C medicines may increase the blood level of tenofovir in PrEP, so be sure to discuss this with your provider if you are considering hepatitis C treatment. Lastly, be aware that you can get hepatitis C again after being treated for it.