Cross-sectional Assessment of HIV and Hepatitis A, B, C, D, and E among Individuals Surveyed in National Health and Nutrition Evaluation Survey, 1999–2018

Main Article Content

Nathaniel R Geyer, DrPH


Objective:  To assess the association with HIV with five strains of viral hepatitis, in adults 18-59 years, who have taken the NHANES survey for HIV, and to determine if there is a positive association with HIV in each of the five viral hepatitis strains adjusted by age, gender, and race.

Methods: Cross-sectional analysis of HIV Screening Test by Laboratory test results for Hepatitis A, B, C, D, and E screenings, using 10 pooled datasets from the 1999-2018 biennial National Health and Nutritional Examination Surveys. Statistical analyses performed included Spearman’s Correlations, weighted Rao-Scott Chi-Square tests, and weighted binary logistic regression modeling.

Results: In the subset of 33,214 adult participants surveyed in the 1999-2018 NHANES the percentage of HIV positivity was 0.44% (standard error=0.05), with 56% occurring in 2009-2018. Weighted Rao-Scott Chi-Square Tests had a statistically significant association between HIV and the five hepatitis strains, with four having a p-value <=0.0001, except for Hepatitis D. After adjustment by age, race, and gender HIV was positively associated odds ratios. Hepatitis A had a statistically significant odds ratio for 1999-2018 but was not significant for 1999-2006 and 2007-2018. Hepatitis B and Hepatitis C had a statistically significant association in all three subsets.  Hepatitis D had no HIV coinfection in 1999-2006, so it was not reported, and a nonsignificant association in 2009-2018. Hepatitis E, which started collection in 2009, had a nonsignificant association with HIV in 2009-2018.

Conclusion: Based on this analysis and the review of HIV and viral hepatitis guidelines it is suggested that immunocompromised individuals, including HIV positives, should be screened for all five strains of viral Hepatitis. Further research is needed in order to better understand the connection between HIV and viral hepatitis strains, especially Hepatitis A, Hepatitis D, or Hepatitis E.

Keywords: NHANES, HIV, Viral Hepatitis A-E

Article Details

How to Cite
GEYER, Nathaniel R. Cross-sectional Assessment of HIV and Hepatitis A, B, C, D, and E among Individuals Surveyed in National Health and Nutrition Evaluation Survey, 1999–2018. Medical Research Archives, [S.l.], v. 9, n. 2, feb. 2021. ISSN 2375-1924. Available at: <>. Date accessed: 29 mar. 2023. doi:
Research Articles


1. Costa‐Mattioli M, Allavena C, Poirier A-S, Billaudel S, Raffi F, Ferré V. Prolonged hepatitis A infection in an HIV-1 seropositive patient. J Med Virol. 2002;68(1):7-11. doi:10.1002/jmv.10163
2. Maki Y, Kimizuka Y, Sasaki H, et al. Hepatitis A virus-associated fulminant hepatitis with human immunodeficiency virus coinfection. J Infect Chemother Off J Jpn Soc Chemother. 2020;26(2):282-285. doi:10.1016/j.jiac.2019.08.010
3. Béguelin C, Moradpour D, Sahli R, et al. Hepatitis delta-associated mortality in HIV/HBV-coinfected patients. J Hepatol. 2017;66(2):297-303. doi:10.1016/j.jhep.2016.10.007
4. Kamar N, Izopet J, Pavio N, et al. Hepatitis E virus infection. Nat Rev Dis Primer. 2017;3(1):1-16. doi:10.1038/nrdp.2017.86
5. Vázquez-Morón S, Berenguer J, González-García J, et al. Prevalence of hepatitis E infection in HIV/HCV-coinfected patients in Spain (2012–2014). Sci Rep. 2019;9(1):1143. doi:10.1038/s41598-018-37328-6
6. Ditah I, Ditah F, Devaki P, Ditah C, Kamath PS, Charlton M. Current epidemiology of hepatitis E virus infection in the United States: Low seroprevalence in the National Health and Nutrition Evaluation Survey. Hepatology. 2014;60(3):815-822. doi:10.1002/hep.27219
7. Patel EU, Thio CL, Boon D, Thomas DL, Tobian AAR. Prevalence of Hepatitis B and Hepatitis D Virus Infections in the United States, 2011–2016. Clin Infect Dis. 2019;69(4):709-712. doi:10.1093/cid/ciz001
8. Klevens RM, Denniston MM, Jiles-Chapman RB, Murphy TV. Decreasing immunity to hepatitis A virus infection among US adults: Findings from the National Health and Nutrition Examination Survey (NHANES), 1999–2012. Vaccine. 2015;33(46):6192-6198. doi:10.1016/j.vaccine.2015.10.009
9. McGivern DR, Lin H-HS, Wang J, et al. Prevalence and Impact of Hepatitis E Virus Infection Among Persons With Chronic Hepatitis B Living in the US and Canada. Open Forum Infect Dis. 2019;6(ofz175). doi:10.1093/ofid/ofz175
10. Liu Z, Shi O, Zhang T, Jin L, Chen X. Disease burden of viral hepatitis A, B, C and E: A systematic analysis. J Viral Hepat. 2020;27(12):1284-1296. doi:10.1111/jvh.13371
11. Jacobsen KH. Globalization and the Changing Epidemiology of Hepatitis A Virus. Cold Spring Harb Perspect Med. 2018;8(10):a031716. doi:10.1101/cshperspect.a031716
12. Miao Z, Zhang S, Ou X, et al. Estimating the Global Prevalence, Disease Progression, and Clinical Outcome of Hepatitis Delta Virus Infection. J Infect Dis. 2020;221(10):1677-1687. doi:10.1093/infdis/jiz633
13. Moss da Silva C, Oliveira JM, Mendoza-Sassi RA, et al. Detection and characterization of hepatitis E virus genotype 3 in HIV-infected patients and blood donors from southern Brazil. Int J Infect Dis. 2019;86:114-121. doi:10.1016/j.ijid.2019.06.027
14. Demi Sibiro OA, Manirakiza A, Komas NP. Seroprevalence of Hepatitis E Virus Infection Among People Living With HIV in the Central African Republic. Open Forum Infect Dis. 2018;5(ofy307). doi:10.1093/ofid/ofy307
15. Ifeorah IM, Faleye TOC, Bakarey AS, et al. Acute Hepatitis E Virus Infection in Two Geographical Regions of Nigeria. Journal of Pathogens. doi:10.1155/2017/4067108
16. Shrestha A, Adhikari A, Bhattarai M, et al. Prevalence and risk of hepatitis E virus infection in the HIV population of Nepal. Virol J. 2017;14(1):228. doi:10.1186/s12985-017-0899-x
17. Tripathy AS, Puranik S, Sharma M, Chakraborty S, Devakate UR. Hepatitis E virus seroprevalence among blood donors in Pune, India. J Med Virol. 2019;91(5):813-819. doi:10.1002/jmv.25370
18. Nimgaonkar I, Ding Q, Schwartz RE, Ploss A. Hepatitis E virus: advances and challenges. Nat Rev Gastroenterol Hepatol. 2018;15(2):96-110. doi:10.1038/nrgastro.2017.150
19. Pisano MB, Martinez‐Wassaf MG, Mirazo S, et al. Hepatitis E virus in South America: The current scenario. Liver Int. 2018;38(9):1536-1546. doi:10.1111/liv.13881
20. Kodani M, Kamili NA, Tejada‐Strop A, et al. Variability in the performance characteristics of IgG anti-HEV assays and its impact on reliability of seroprevalence rates of hepatitis E. J Med Virol. 2017;89(6):1055-1061. doi:10.1002/jmv.24741
21. Nelson NP. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020;69. doi:10.15585/mmwr.rr6905a1
22. Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67(1):1-31. doi:10.15585/mmwr.rr6701a1
23. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep. 2020;69(2):1-17. doi:10.15585/mmwr.rr6902a1
24. Rivero-Juarez A, Lopez-Lopez P, Frias M, Rivero A. Hepatitis E Infection in HIV-Infected Patients. Front Microbiol. 2019;10. doi:10.3389/fmicb.2019.01425