Hiv And Aids Diagnosis
HIV tests check your blood or fluid from your mouth for antibodies that your body makes in response to the virus. You can take them at a doctorâs office, a community health center, a hospital, or at home.
When you have HIV, your doctor will keep an eye on how much of the virus is in your system. You might hear them call it your âviral load.â Two things will tell them if your infection has become AIDS:
- Your CD4 count. A person with a healthy immune system has 500 to 1,600 CD4 cells in a cubic millimeter of their blood. A person with AIDS has fewer than 200. This number is called your âCD4 count.â
- AIDS-defining infections. These are also called opportunistic infections. These generally happen in people who have a CD4 count below 200. Viruses, bacteria, or fungi that donât usually make healthy people sick can cause these infections in someone with HIV or AIDS.
How long it takes HIV to become AIDS is different for everyone. If you donât get treatment, it might take 10 to 15 years. With treatment, you may never have AIDS.
Contaminated Needles And Infected Blood
You can get hepatitis C from sharing contaminated needles, syringes and other injecting equipment during recreational drug use. Banknotes and straws used for snorting may also pass the virus on.
Being exposed to unsterilised tattoo and body piercing equipment can also pass hepatitis C on. Occasionally, you can get it from sharing a towel, razor blades or a toothbrush if there is infected blood on them.
Hepatitis C infection is also passed on in healthcare settings, from needle stick injuries or from medical and dental equipment that has not been properly sterilised. In countries where blood products are not routinely screened, you can also get hepatitis C by receiving a transfusion of unscreened blood and blood products.
You can prevent hepatitis C by:
- never sharing needles and syringes or other items that may be contaminated with infected blood
- only having tattoos, body piercings or acupuncture in a professional setting, where new, sterile needles are used
- following the standard infection control precautions, if youre working in a healthcare setting.
What Is Chronic Infection With Hepatitis B
Early in the infection, most people will clear the virus without treatment and develop protective immunity. However, in 5-10% of adults hepatitis B continues to reproduce in the body long after infection. These people become chronically infected with hepatitis B, meaning that they continue to be infectious although they may not experience any symptoms at all, or not for many years.
People living with HIV, especially if they have a low CD4 cell count, are less likely to clear the virus naturally than people without HIV.
Without treatment, some people with chronic hepatitis B eventually develop cirrhosis of the liver. About one in 20 people with cirrhosis will go on to develop cancer of the liver.
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Improving Access For Key Populations
For people from key populations, stigma and structural barriers continue to hinder access to diagnosis, treatment and care for hepatitis C.44 .
To ensure equitable access and engage key populations, clinical services for hepatitis C will need to better adapt their models of care. They may need to provide outreach services, be flexible around appointment requirements, train staff, and consult civil society- and community-led organisations .45
Buyers clubs pool resources to buy DAA medicines via the internet. There are many buyers clubs around the world enabling people to access treatment who would otherwise be unable to receive it. They exist as a stopgap response to the failure of public health systems to ensure equitable access to hepatitis C treatment.
However, there are concerns that compromise other important aspects of treatment, including treatment monitoring and management of co-infection.46
Is Hepatitis Testing Recommended For People With Hiv
Yes. Everyone living with HIV should be tested for HBV and HCV when they are first diagnosed with HIV and begin treatment. People living with HIV who have ongoing risk factors for getting hepatitis B or hepatitis C should be tested annually.
In addition, new HCV screening recommendations from the Centers for Disease Control and Prevention call for:
- One-time screening for all adults 18 years and older
- Screening of all pregnant women during every pregnancy
- Testing for all persons with risk factors, with testing continued periodic testing those with ongoing risk.
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Can Hepatitis C Be Treated
Yes, since 2010 enormous progress has been made in the treatment of chronic hepatitis C. New therapies called direct-acting antivirals are pills that act on the virus itself to eradicate it from the body, unlike older medicines like interferon injections which work by stimulating an immune response. These new treatments are very effective and can achieve cure rates of over 90%. In most situations now, there is no need for interferon, which was responsible for many of the side effects previously associated with HCV treatment. The new treatment combinations require shorter treatment durations , have reduced side effects and appear to be effective at all stages of the disease.
Because these new therapies are very new, they remain very expensive. As such, drug coverage from both government and private companies may require that your liver disease has progressed to a certain stage before they are willing to cover the cost of these drugs.
Your primary care physician may refer you to a specialist to determine whether you are eligible for treatment. A specialist will help you decide which drug therapy is best for you based on the severity of your liver disease, your virus genotype and whether or not you have been treated in the past.
Contaminated Body Piercing Or Tattoo Equipment
Although rare, it’s possible to be exposed to HIV in a piercing or tattoo establishment that reuses or does not sanitize needles, ink, and other supplies.
Before having any sort of body art procedure that involves needles or skin punctures, make sure the practitioner is licensed and follows strict sanitation guidelines.
Can Hepatitis A Be Prevented
The following will help keep people safe from hepatitis A:
- regular hand washing, especially after going to the bathroom or diapering a baby, and before eating
- washing fruits and vegetables before eating them
- not eating raw shellfish, such as raw oysters
- getting the vaccine for hep A
Getting vaccinated helps a person’s body make antibodies that protect against hepatitis infection. The hepatitis A vaccine is now given to all kids when they’re between 1 and 2 years old, and to people who are traveling to countries where the virus could get into the food and water supply.
The Epidemiology Of Hiv/hepatitis C Co
It is estimated that 6.2% of people living with HIV also show signs of past or present hepatitis C infection. This equates to 2.3 million people living with HIV, over half of whom are .7 Injection drug use accounts for 23% of new hepatitis C infections while 8% of people living with chronic hepatitis C currently inject drugs.8
Among people living with HIV, the prevalence of hepatitis C is highest in people who inject drugs , followed by and pregnant women .9 Studies also show very high rates among living with HIV, although less data has been collected.
As a result, developing models of care that meet the needs of people from these key populations is a vital first step to providing an effective co-infection treatment programme. However, the proportion of people living with HIV and hepatitis C co-infection varies considerably, according to risk group and world region.
In 2016, low- and middle-income countries accounted for about 75% of people living with hepatitis C. China has the largest hepatitis C epidemic , followed by Pakistan , India and Egypt . These four countries account for almost 40% of all people living with hepatitis C.10
Eastern Europe is home to the greatest number of people living with HIV-hepatitis C co-infection, estimated to be around 600,000 people.11 Around 400,000 people in sub-Saharan Africa are also living with HIV/hepatitis C co-infection.12
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Symptoms Of Hepatitis C
Many people with hepatitis C have no symptoms at all. When symptoms do occur they often involve the following:
- stomach problems
- jaundice a yellowing of the skin and eyes.
Some people will clear the virus without treatment, but this is less likely in the case of people living with HIV.
For most people, hepatitis C continues to reproduce in the body long after infection, turning into a chronic infection. This means that they continue to be infectious, although they may not experience any symptoms at all, or not for many years.
Even with a lack of symptoms, the virus may still be damaging the liver, causing fibrosis a hardening of the liver. This can lead to cirrhosis, which is a permanent scarring of the liver. Cirrhosis increases the risk of liver cancer.
How Is It Treated
Hepatitis A is treated using supportive methods. These can include things like rest, fluids, and healthy foods. Medications can also help to ease some symptoms like fever, aches, and pains.
Theres a vaccine available to protect against infection with HAV. This is typically recommended for children as well as for people at an increased risk for contracting the virus.
Also, receiving a single dose of the hepatitis A vaccine may prevent you from becoming ill if youve been exposed to HAV. For it to be effective, the vaccine needs to be given of exposure.
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What Is The Risk Of Coinfection
A coinfection is when someone has two or more infections at the same time. People living with HIV are at risk of developing coinfections such as hepatitis C because HIV weakens the immune system, which leaves the body more vulnerable to other infections and illnesses.
HIV and HCV are also transmitted in similar ways, which means that people who have HIV may be at higher risk of exposure to HCV. In the United States, over a third of people living with HIV also have hepatitis C.
Coinfection of HCV and HIV is higher among those who use injected drugs. According to the Centers for Disease Control and Prevention , HCV coinfection occurs in between 62 and 80 percent of people with HIV who use injected drugs.
A systematic review of 783 studies concluded that people living with HIV were six times more likely to have hepatitis C than people without HIV.
Hepatitis C infections are more serious in people with HIV and can lead to more severe damage of the liver. HIV and HCV coinfections can increase the risk of:
- liver fibrosis and cirrhosis, which is a buildup of scar tissue in the liver
- end-stage liver disease
A person can contract HCV through direct contact with blood or other body fluids that contain the virus. Possible modes of transmission include:
Ways to prevent hepatitis C include:
- not sharing needles
How Should The Liver Be Monitored
Everyone with HIV should have regular tests to monitor the health of their liver. These tests are especially important in cases of coinfection with hepatitis B. In those cases, doctors should closely monitor liver function using blood tests.
Ultrasound examinations may also be performed, particularly if the liver shows signs of damage. Another test, called a FibroScan, can also test the liver for cirrhosis or fibrosis.
Sometimes, people also need a liver biopsy, where a tiny piece of tissue from the liver is removed for investigation.
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Who Is More Likely To Get Hepatitis B
People are more likely to get hepatitis B if they are born to a mother who has hepatitis B. The virus can spread from mother to child during birth. For this reason, people are more likely to have hepatitis B if they
- were born in a part of the world where 2 percent or more of the population has hepatitis B infection
- were born in the United States, didnt receive the hepatitis B vaccine as an infant, and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection
People are also more likely to have hepatitis B if they
- are infected with HIV, because hepatitis B and HIV spread in similar ways
- have lived with or had sex with someone who has hepatitis B
- have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
- are men who have sex with men
- are injection drug users
- work in a profession, such as health care, in which they have contact with blood, needles, or body fluids at work
- live or work in a care facility for people with developmental disabilities
- have been on kidney dialysis
- live or work in a prison
- had a blood transfusion or organ transplant before the mid-1980s
In the United States, hepatitis B spreads among adults mainly through contact with infected blood through the skin, such as during injection drug use, and through sexual contact.12
Diagnosing Hepatitis C In People Living With Hiv
Everyone with HIV should be tested to see if they also have hepatitis C. A blood test for antibodies to hepatitis C is used to see whether you have been exposed to the virus. You might be given a PCR test to confirm infection.
In people living with HIV, the diagnosis of hepatitis C can be more difficult, as the infection may not show up on their antibody tests.
If you think you may be at risk of hepatitis C infection, you should have regular tests to see if you have been infected with the virus.
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Hiv And Hepatitis And Participation In Sport
The Equal Opportunity Act 2010 makes it unlawful in Victoria to fail or refuse to select a person with HIV or hepatitis B or C for a sporting team, or to exclude them from participating in a sporting activity, because they have HIV or hepatitis B or C. People with these viruses are not required to disclose their health status to coaches, sporting teams or sporting organisations. They are entitled to keep the fact that they have HIV, hepatitis B or C confidential.
How Is The Health Of Your Liver Monitored
Everyone living with HIV should have regular tests to monitor the health of their liver as part of the routine check-ups carried out by their HIV clinic. These tests are especially important if you have hepatitis C.
These include liver function tests that monitor levels of liver enzymes. Ultrasounds and scans are also important monitoring tools which may be used if more information is needed.
Sometimes its necessary to have a liver biopsy. This involves the removal of a small amount of the liver, under a local anaesthetic, for further tests on the health of your liver.
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Treating Hepatitis C Together With Hiv
If youre HIV positive and have hepatitis C infection, then you must receive care from a doctor skilled in the treatment of both HIV and hepatitis.
Due to the new direct-acting antiviral drugs, people living with HIV and hepatitis C co-infection can be treated with most of the same hepatitis C drug regimens as HIV-negative people. Research has shown that cure rates are the same.
Unlike treatment for HIV, hepatitis C treatment is not for life. New drugs to treat hepatitis C only need to be taken for up to 3 months.
What Do Doctors Do
A doctor who thinks someone may have hepatitis may ask questions like these:
- Has the person been around anyone who works in health care or childcare?
- Did the person stick himself or herself with a dirty needle or get a tattoo with a dirty needle?
- Did the person have contact with the bodily fluids of someone who has hepatitis?
- Did the person have a blood transfusion as a baby?
- Have any of the person’s family members had hepatitis?
- Could the person have eaten food that was contaminated with hepatitis A?
The doctor can order a blood test to see if someone has hepatitis and which type, then help the person get the right care.
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Effects Of Chronic Hepatitis On The Treatment Of Hiv Infection
Current data do not suggest that chronic hepatitis B or C affect the natural course of HIV infection. However, hepatotoxicity secondary to HIV treatment is more common among patients with chronic viral hepatitis, especially among females with high baseline CD4 counts. The incidence of hepatotoxicity secondary to HAART has been reported to be between 2-18% among the major series., Invariably, HBV or HCV is among the factors associated with drug-induced liver injury. Regular monitoring of liver function tests is required during HAART.
Furthermore, a number of drug interactions are noteworthy. For the treatment of HCV-HIV co-infection, ribavirin should not be used together with nucleoside reverse transcriptase inhibitors didanosine and stavudine because of the risk of mitochondrial toxicity. This may lead to acute pancreatitis, lactic acidosis, hepatic steatosis and liver failure. Zidovudine should be avoided during HCV treatment because it increases the risk of anaemia and neutropaenia. Subgroup analysis of one study showed that protease inhibitors may reduce the treatment efficacy of PEG-IFN and ribavirin in HCV-HIV co-infected patients, but this needs further confirmation.
How Are Hepatitis B And Hepatitis C Spread From Person To Person
Like HIV, the hepatitis B and hepatitis C viruses spread:
- From mother to child: Pregnant women can pass these infections to their infants. HIV-HCV coinfection increases the risk of passing on hepatitis C to the baby.
- Sexually: Both viruses can also be transmitted sexually, but HBV is much more likely than HCV to be transmitted sexually. Sexual transmission of HCV is most likely to happen among gay and bisexual men who are living with HIV.
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