Hiv: On Our Way To Global Control
Considering its high effectiveness, the WHO and UNAIDS have recommended Treatment as Prevention for HIV to be widely implemented . It has been demonstrated that effective treatment suppresses the viral load, and this correlates with a significantly decreased chance of transmission to uninfected individuals . The landmark HIV Prevention Trials Network published a landmark trial in 2011, showing that treating HIV-infected individuals from a discordant couple was 96% effective in preventing HIV infection of their partner . In addition, no linked infections were observed when HIV was successfully undetectable by ART . A more recent study conducted within Danish men who have sex with men demonstrated that TasP could contribute to HIV epidemic elimination when the treatment coverage and viral load suppression rate are high . Finally, these observations were confirmed by the large Partner-1 and -2 studies again clearly demonstrating no HIV transmissions when there is an undetectable viral load after nearly 77,000 acts of condomless sex.
The Impact Of Hiv On Hepatitis C
The interaction between HIV and hepatitis C affects the transmission and natural history of hepatitis C.13 People who do not receive HIV treatment are less likely to spontaneously clear their hepatitis infection, have higher hepatitis viral loads and experience more rapid hepatitis disease progression than HIV-negative people.
They may also belong to groups that are criminalised and stigmatised, meaning they are likely to experience barriers to accessing health services.14On the other hand, antiretroviral treatment taken to treat HIV helps keep hepatitis C under control. Hepatitis outcomes are better in people who receive HIV treatment. Whereas response to the older generation of hepatitis C treatments was poorer in people with HIV, this is not the case with modern therapies.
What Is Hepatitis B
Hepatitis B is a liver infection caused by the hepatitis B virus . The abbreviation HBV can stand for either the virus or the infection it causes.
HBV can be a short-term or a long-term illness:
- Acute HBV occurs within 6 months after a person is exposed to HBV. In some people, acute HBV can lead to chronic HBV.
- Chronic HBV is a lifelong disease. Without treatment, chronic HBV can cause liver cancer or liver damage that leads to liver failure.
HBV is a contagious infection that can spread from person to person.
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Detection Of Serum Cytokines
Within the HBV mono-infected group, only PDGF was statistically significantly different in concentration between the treated and untreated patients with the treated having median 3.84 ng/ml compared to 2.97 ng/ml among untreated patients, p=0.04. We therefore considered the treated and untreated HBV mono-infected patients as a single group for multigroup comparison. Levels of basic fibroblast growth factor, IL-9 and IL-17 were particularly elevated in the HBV mono-infected group . Serum levels of IP-10 were high among co-infected patients. TGF-beta isotypes were highly expressed in the HIV-mono-infected group. Analysis of serum cytokine concentrations was also performed excluding the control group significance levels . Correlation was analysed for all study participants as a single group as well as according to their infection status using all continuous variables measured in the study. There were significant positive correlations between IP-10 and sCD14 and IP-10 with LBP . IP-10 was also positively correlated with HIV viral load and HBV viral load in the co-infected group. Principle component analysis of serum cytokine concentrations showed relatively good distinction between HBV mono-infected, HBV/HIV co-infected patients from the HIV mono-infected and controls. There was poor distinction between the HIV mono-infected participants and controls .
Table 4 Median plasma cytokine concentrationsFig. 2
Treating Hepatitis C In People With Hiv Co
DAAs have good outcomes for people previously considered hard-to-treat. This includes people with HIV co-infection. The outcomes of treatment in people with co-infection are comparable to those in people with hepatitis C alone – rates of sustained virological response are over 95%, even in individuals who have not responded to previous treatment and people with cirrhosis.38There is no longer a need to consider HIV/HCV- co-infected patients as a special, difficult-to treat patient population, WHO states in its 2016 guidance.39
The key issue that remains, WHO emphasises, is the potential for drug-drug interactions between medications for HIV and hepatitis C. When these may occur, the regimens for either infection may need to be altered.40 However, modern HIV medications rarely have the harmful effects on the liver that characterised some older drugs. Hepatitis C treatment is generally provided to people who are already taking HIV treatment.41
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What Is The Difference Between An Std And Sti
The term STD is often used interchangeably with the term sexually transmitted infection . But despite this common misconception, STDs and STIs arent exactly the same. Each term has a specific meaning:
- STI. An STI is a sexually transmitted infection and doesnt cause any symptoms. Instead, an STI refers to the presence of the virus, bacteria, or other pathogens in your body.
- STD. An STD is a sexually transmitted disease, which does cause symptoms. It happens when the pathogens in your body have led to the cell damage that produces symptoms.
Put simply, an infection just means the presence of the pathogen is in your body, while a disease means youre having symptoms. A condition is only considered an STD if there are symptoms.
This might seem like a small difference, but the distinction is important. This is especially true for STIs that rarely cause symptoms, like chlamydia or gonorrhea. For many people, these STIs wont ever progress to STDs.
People Coinfected With Hiv And Viral Hepatitis
People with HIV/AIDS should be vaccinated against hepatitis A and B and tested for hepatitis B and hepatitis C.
Beginning in 2020, CDC and the Advisory Committee on Immunization Practices began recommending that all people with HIV who are 1 year of age be vaccinated against hepatitis A and receive postvaccination serologic testing 1 month after completing the hepatitis A vaccine series.
Further, CDC and ACIP recommend that unvaccinated people with HIV receive hepatitis B vaccination. Vaccination should be followed by serologic testing to confirm adequate immune response. CDC recommends that people with HIV be tested for hepatitis B.
CDC now also recommends one-time hepatitis C testing of all adults , including those with HIV. CDC continues to recommend people with risk factors, like people who inject drugs, be tested regularly.
People with HIV and Hepatitis A
People with HIV and Hepatitis B
People with HIV and Hepatitis C
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Risks Of Contracting Hiv And Stds
Just as HIV and STDs are spread in the same ways, they can also share some of the same risk factors. A risk factor is anything that makes you more likely to contract a condition or disease.
For HIV and some STDs, risk factors include:
- having unprotected sex of any kind
- sharing injection needles
- sharing tattoo or piercing needles
- having sexual encounters under the influence of drugs or alcohol
The risks of contracting HIV or an STD are also higher among some populations and groups. This can be due to a variety of factors, like:
- lack of access to healthcare
- discrimination faced in accessing healthcare
- population size
47 percent of primary and secondary syphilis were among men who have sex with men. But STDs are common among all Americans. Its important for anyone of any gender or sexuality who has one or more risk factors to get tested and treated.
How Do You Get Hepatitis B
Hepatitis B is really contagious. Its transmitted through contact with semen , vaginal fluids, and blood. You can get it from:
-
having vaginal, anal, or oral sex
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sharing toothbrushes and razors
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sharing needles for shooting drugs, piercings, tattoos, etc.
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getting stuck with a needle that has the Hep B virus on it.
Hepatitis B can also be passed to babies during birth if their mother has it.
Hepatitis B isnt spread through saliva , so you CANT get hepatitis B from sharing food or drinks or using the same fork or spoon. Hepatitis B is also not spread through kissing, hugging, holding hands, coughing, sneezing, or breastfeeding.
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What Is The Difference Between Hepatitis B & C
Hepatitis B is caused by coming into contact with bodily fluids of an infected person, where Hepatitis C is transmitted by blood-to-blood contact. Both are viral infections that affect the liver, and it is possible to have both Hepatitis B and Hepatitis C at the same time. Many people with Hepatitis C were born with the condition between 1945 and 1965.
What Are The Risk Factors
Some people are at an increased risk for contracting HAV, including:
- people traveling to areas of the world where hepatitis A is common
- men who have sex with men
- people who use injectable or noninjectable drugs
- caregivers for those who have hepatitis A
- people who are experiencing homelessness
- people living with a child whos been adopted from an area where hepatitis A is common
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How Is Hepatitis B Transmitted
Hepatitis B is spread in several distinct ways: sexual contact sharing needles, syringes, or other drug-injection equipment or from mother-to-child at birth.
In the United States, in 2018, injection drug use was the most common risk factor reported among people with an acute HBV infection, followed by having multiple sex partners. Less commonly reported risk factors included accidental needle sticks, surgery, transfusions, and household contact with a person with HBV infection. In the United States, healthcare-related transmission of HBV is rare.
Mother-to-child transmission of HBV is especially concerning, because it is preventable. An estimated 25,000 infants are born to mothers diagnosed with HBV each year in the United States, and approximately 1,000 mothers transmit HBV to their infants. Without appropriate medical care and vaccinations, 90% of HBV-infected newborns will develop chronic infection, remaining infected throughout their lives. Up to 25% of people infected at birth will die prematurely of HBV-related causes. For this reason, the standard of care for pregnant women includes an HBV test during each pregnancy so that the appropriate steps can be taken to prevent HBV-positive mothers from transmitting the disease to her infant.
How Can You Prevent Hepatitis B And Hepatitis C
Hepatitis B: Vaccination is the best way to prevent all of the ways that hepatitis B is transmitted. People with HIV who do not have active HBV infection should be vaccinated against it. In addition to the 3-dose series of hepatitis B vaccine given over 6 months, as of 2017, there is a 2-dose series given over 1 month.
Hepatitis C: No vaccine exists for HCV and no effective pre- or postexposure prophylaxis is available. The best way to prevent hepatitis C infection is to never inject drugs or to stop injecting drugs by getting into and staying in drug treatment. If you continue injecting drugs, always use new, sterile needles or syringes, and never reuse or share needles or syringes, water, or other drug preparation equipment.
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Spreading Hiv And Stds
HIV and STDs are both contracted by having unprotected sexual contact of any kind. This includes vaginal, anal, and oral sex.
But sexual contact isnt the only way to contract an STD or HIV. Pathogens like HIV, hepatitis B, and hepatitis C can also be spread by sharing needles or other drug paraphernalia.
Birthing parents can also pass HIV and some STDs on to babies while pregnant, during delivery, or through breastfeeding. For example, chlamydia and gonorrhea are two types of pathogens that can be passed to a baby during delivery.
Hiv And Hepatitis B And Hepatitis C Coinfection
Hepatitis B and hepatitis C are liver infections caused by a virus. Because these infections can be spread in the same ways as HIV, people with HIV in the United States are often also affected by chronic viral hepatitis.
Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Liver disease, much of which is related to HBV or HCV, is a major cause of non-AIDS-related deaths among people with HIV.
Given the risks of hepatitis B or hepatitis C coinfection to the health of people living with HIV, it is important to understand these risks, take steps to prevent infection, know your status, and, if necessary, get medical care from someone who is experienced in treating people who are coinfected with HIV and HBV, or HIV and HCV.
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The Outlook For Hepatitis C And Hiv Coinfection
Hepatitis C treatment is currently provided in specialised centres by hepatologists. To expand access, treatment will need to be provided by non-specialists in primary-care clinics. Large numbers of healthcare workers will need training in the clinical management of hepatitis C.
Shifting to this public health approach is one of several ways in which simplified and standardised procedures could help bring hepatitis C treatment to scale provided the costs of drugs and monitoring is reduced.
There remains a long way to go before the world will be on track to reach the WHO target of eliminating hepatitis C as a major public health threat by 2030. Reaching this goal means diagnosing 90% of people living with hepatitis C and putting 80% on treatment, while drastically reducing new hepatitis C infections.58 For this to happen, efforts in each of these areas will need to be greatly accelerated. But until political and financial support for integrated hepatitis C, harm reduction and HIV diagnosis, treatment and care becomes a global health priority these targets may remain unreachable.
Treatment For Chronic Hbv Infection
For chronic HBV infection, antiviral medications are available.
This is not a cure for chronic HBV. However, it can stop the virus from replicating and prevent its progression into advanced liver disease.
A person with a chronic HBV infection can develop cirrhosis or liver cancer rapidly and without warning. If a person does not have access to adequate treatment or facilities, liver cancer can be fatal within months of diagnosis.
People with a chronic HBV infection require ongoing medical evaluation and an ultrasound of the liver
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How Is Hepatitis Diagnosed
Getting tested for hepatitis is important to help detect infection early. Tests may even detect hepatitis before symptoms begin. In people with HIV, this is especially important so that they may receive treatment early. Testing for hepatitis may also reduce transmission to others.
Hepatitis is diagnosed with blood testing. This may involve:
- antibody testing for HAV
- hepatitis B surface antigen, to detect either acute or chronic infections of HBV
- hepatitis C antibody test if antibodies are found in the blood, your doctor may order a follow-up test to confirm HCV
- liver function tests, which may find chronic hepatitis infections
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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Where We Are Now
UNAIDS and WHO have approved different global strategies to achieve elimination of HIV, HBV and HCV as public health issues by 2030. The burden of the three infections is still high worldwide with approximately 257 million people with chronic HBV infection, 71 million people chronically infected with hepatitis C and an estimated 36.7 million people living with HIV. There are important differences between the viruses with respect to geographical distribution and routes of transmission that influence plans and strategies for worldwide elimination. The principal targets of the eliminations programs are based on implementing current available preventive strategies and treatment options . Applying for all three viruses is that the availability of effective antivirals is mandatory for worldwide elimination. In addition, easy-to-use point-of-care testing already available for HIV and HCV should routinely be used to lower the barriers of diagnosis and linkage to care.
Table 3 UNAIDS strategy 20162021 and WHO targets 2030 based on the total number of 36.7 million people living with HIV worldwide in 2016 according to WHO
Treatment For Genotype 1 Of Hepatitis C
The evidence supports that the beginning of the antiretroviral therapy and, therefore, controlling early replication of HIV and maintaining a good immunological situation are the first measures to adopt in the coinfected patients. Existing data indicate that antiretroviral treatment can slow down the progression of chronic HCV liver disease in the coinfected patient, even in the carriers of liver disease, increasing their survival .
Studies based on liver biopsies have demonstrated a relationship between the management of antiretroviral treatment, immunological improvement, and the presence of lower grades of hepatic fibrosis .
3.2.1 Boceprevir or telaprevir + PR
In patients coinfected with HIV and HCV genotype 1 and without previous treatment for HCV SVR after treatment with Boceprevir or telaprevir was higher than in those treated with PR .
Efficacy and side effects with both triple patterns were similar to those observed in monoinfected patients. The dose of RBV was 800 mg/d in almost all patients. Although significant pharmacokinetic interactions have been described, the co-administration of lopinavir/r, atazanavir/r, and darunavir/r, allowed in the study with PR/BOC, did not affect efficacy .
The results of the Unite 115 study support the dosage of TVR every 12 h in coinfected patients and ART based on IP/r or raltegravir, as well as the possibility of shortening the duration to 24 weeks in patients without cirrhosis with HCV-RNA undetectable in S4 and S12.
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