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.
Hepatitis B In Uganda
Country leads in tackling growing health challenge
Kampala, Uganda | PATRICIA AKANKWATSA | Up to 6% of people in Uganda are infected with Hepatitis B a virus that can cause acute and chronic liver infections which is incurable.
That means if you are in a place with 15 people at least one of them, on average, has the infection.It is serious because dying of viral hepatitis in Africa is becoming a bigger threat than dying of AIDS, malaria or tuberculosis.
Similar to HIV, hepatitis B virus is transmitted through unprotected sex, infected blood products and items such as needles, razor blades, dental or medical equipment, unscreened blood transfusions, or from mother to child at birth.
Unfortunately 90% of the infected people do not know it because they do not show any signs of sickness and therefore can easily infect others.
Emma Lutamaguzi was one of them. Although he knew that his dream of working overseas meant he would have to undergo strict medical tests, he was confident he would pass because he felt and looked healthy.
But his dream was shattered when he was diagnosed with Hepatitis B Virus .
When the doctor told me, I was a little scared because this is something that I had no idea about, he says.
The doctor referred him to another doctor who, unfortunately, told him scary stories about the infection.
He made the situation worse for me, Lutamaguzi recalls, He was money oriented.
Risk
Elimination strategy
Challenges
Hepatitis B quick facts
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So Why Dont We Have A Vaccine Yet
I hear you then we should have a vaccine so that people never get HIV at all. But unfortunately its not that simple. In order to create a vaccine, you need to be able to infect people with a weakened form of a virus, and that weakened virus must have the ability to induce the immune system to make neutralising antibodies. These antibodies usually appear at 12 weeks after HIV infection. The special thing about neutralising antibodies is that they can inactivate the virus.
BUT and heres the thing HIV is a rapidly evolving virus. It constantly mutates during replication to create new variants Which cannot be neutralised by the antibodies that are currently being produced. So the body creates new neutralising antibodies against the resistant forms, but HIV has already evolved another resistant form. This means that even if you can come up with a weakened form of virus for a vaccination, the elicited antibody will only be effective for a small percentage of the viral population, and the rest will persist.
There have been numerous failed vaccine trials, but scientists gain a greater understanding with each trial, and are getting closer and closer to being able to design an effective vaccine.
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How Hepatitis B C Are Silently Killing India
Highlights
- Hepatitis B is 50-100 times more infectious than HIV
- About one million Indians are at risk of acquiring Hepatitis B
- 10,000 die from Hepatitis virus every year
New Delhi: Despite the cost of drugs coming down and dramatic advances in the treatment of Hepatitis B and Hepatitis C, getting rid of both types of the disease remains a huge challenge primarily due to lack of awareness and unsafe injection practices, experts have rued.
Hepatitis B is 50-100 times more infectious than HIV and Hepatitis C is 10 times more infectious than the virus that can cause AIDS. Yet, while people are by and large aware of HIV, there is little awareness about Hepatitis, health experts have lamented.
In India, Hepatitis is a matter of concern because three to six billion injections are given each year, of which two-thirds are unsafely administered. This makes a large part of the population vulnerable to viruses transmitted through the blood, Siddharth Srivastava, Associate Professor, GB Pant Hospital said.
Hepatitis B and C are silent killers. They live in the body for decades, without showing any symptoms. When symptoms finally appear, they signal that the liver itself has been affected, making treatment difficult.
About one million Indians are at risk of acquiring Hepatitis B infection and about 10,000 die from the virus every year. This number is huge especially considering the fact that it is a vaccine-preventable disease, Srivastava said.
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Awareness Prevention And Early Diagnosis Are Essential
There’s a good reason why hepatitis C is known as a “silent killer.”
According to the U.S. Centers for Disease Control and Prevention, an estimated 3.2 million Americans live with chronic hepatitis C infection, which is transmitted through infected bodily fluids like blood and semen, and causes inflammation of the liver. Yet up to 75% of people who have hepatitis C aren’t aware they have it.
Most of those living with the virus experience only mild symptoms or don’t have any symptoms at all until they develop serious liver damage or another life-threatening liver disease. Unfortunately, that means they aren’t getting diagnosed and treatment is delayed until the later stages when irreversible liver damage has occurred.
Here, hepatologistNancy Reau, MD, associate director of the Solid Organ Transplant Program at Rush University Medical Center, explains who is at risk for hepatitis C and offers advice to help you protect yourself.
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An Hiv Success Story: The Berlin Patient
As a glimpse of hope, we do have an anomaly a success story of HIV being cured in the most roundabout way when HIV positive Timothy Ray Brown had to get a stem cell transplant as a treatment for his leukaemia. Although scientists have a number of theories about how this worked, they all agree that Brown became the first man to be cured of HIV.
Treating Hepatitis A B C: Id Care Infectious Disease Doctors
According to Dr. Aslam, ID Cares unique experience treating chronic illnesses like HIV is what sets us apart. We identify the risk factors, diagnose the strains, and do a lot of community teaching where our patients live. Some of the hepatitis patients were trying to help are IV drug users. Because of our experience treating people with HIV, we have a lot of community and healthcare connections, and we can help patients get into detox and recovery programs to break habits that raise the risk for hepatitis B and C.
Sometimes, the complex antiviral medicines used for hepatitis B and C can interact with other drugs, and some patients are resistant to their effects. Interestingly, some people who have hepatitis B or C along with HIV may be prescribed hepatitis medications that can affect their HIV as well. If you have both the diseases, a combination treatment is best, otherwise, patients can develop resistance, warned Dr. Aslam, adding that close monitoring is key in these cases.
Difficult, multi-disease scenarios do happen, and according to Dr. Aslam, ID Care is better trained, equipped, and experienced to detect and address the complications, drug interactions, and side issues like drug dependence, depression, and substance abuse that can interfere with successful treatment. We provide a uniquely high level of care to our patients with viral hepatitis and related problems.
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Integrating Services For Pregnant Women And Their Babies Reduces Time Required To Provide Care By 32% For Pregnant Women
Cambodia is starting to integrate HBV into its existing elimination of vertical transmission program, which already includes screening for HIV and syphilis. The program design for pregnant women includes HBV screening, further diagnosis in women who screen positive, TDF therapy when needed, and HepB birth dose for all infants. The program prioritizes access, offering services at health centers, maternity wards, and hospital HBV units.
Coordinating and integrating services for pregnant women and their babies help to maximize their effectiveness, efficiency, and sustainability. A study conducted in Cambodia highlighted that providing integrated services for elimination of vertical transmission of HIV, HBV, and syphilis reduces the total time required to provide care by 19 percent for health workers and by 32 percent for pregnant women.
Continued strong political commitment for triple elimination, strengthened integrated maternal and child health services, strengthened interdepartmental coordination, and sustained financing will be key to Cambodias continued progress towards its HBV elimination of vertical transmission goals said Dr. Kim Rattana, Director of Cambodias National Maternal and Child Health Center.
Hepatitis Symptoms In Men And Women
For both men and women, viral hepatitis can cause nausea, vomiting, abdominal pain, and jaundice, which is yellowish discoloration of the skin and the whites of the eyes. According to Dr. Aslam, you can have fevers, your urine will be dark, your stool will be pale, you can have joint pain, and with hepatitis B and C, you can develop a rash. Sometimes the B and C strains can affect the kidneys, as well. If advanced liver disease develops, other systemic complications may crop up, such as blood clotting difficulty and fluid retention in the belly.
If you experience these ongoing symptoms with no other obvious cause, talk to your doctor about getting tested for viral hepatitis. Early detection and treatment offer the best chance of a speedy recovery. ID Care has a team of infectious disease experts that specialize in viral hepatitis diagnosis and treatment to ensure optimal health outcomes.
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Medications For Hepatitis B
Several drugs are currently available for treatment of hepatitis B. Most of these are antiviral drugs that directly stop hepatitis B from reproducing. Hepatitis B treatment may also include pegylated interferon, which stimulates the body’s immune response against the virus.
Most hepatitis B drugs are nucleoside or nucleotide analogues, similar to one class of drugs used to treat HIV. In fact, some commonly used anti-HIV drugs are also active against hepatitis B. This can make treatment of both viruses easier, since it requires fewer drugs, but it must be done carefully to avoid either virus becoming resistant. These are:
- lamivudine .
- emtricitabine .
- tenofovir disoproxil or TDF .
- tenofovir alafenamide or TAF .
Other antiviral drugs are used to treat hepatitis B but not HIV:
- adefovir
- telbivudine .
Hepatitis B Facts And Figures
Hepatitis B is a global public health threat and the worlds most common serious liver infection. It is up to 100 times more infectious than the HIV/AIDS virus. It also is the primary cause of liver cancer , which is the second-leading cause of cancer deaths in the world.
Hepatitis B Around the World
- Two billion people have been infected with the hepatitis B virus .
- Approximately 1.5 million people become newly infected each year.
- Almost 300 million people are chronically infected.
- Approximately 10% of infected individuals are diagnosed.
- An estimated 820,000 people die each year from hepatitis B and related complications such as liver cancer.¹
- Approximately two people die each minute from hepatitis B.
Hepatitis B In the United States
1. In 2019, there were approximately 820 000 people who died from hepatitis B-related causes globally: Web Annex 1. Key data at a glance. In: Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Accountability for the global health sector strategies 20162021: actions for impact. Geneva: World Health Organization 2021. License: CC BY-NC-SA 3.0 IGO.
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New Approaches To Ending Vertical Transmission Of Hbv That Overlap With Hiv
In July 2020, the WHO released new guidelines to reduce vertical transmission of HBV. The guidelines recommend pregnant women with high HBV viral loads receive tenofovir prophylaxis from the 28th week of pregnancy until at least birth. This recommendation is in addition to the three-dose hepatitis B vaccination in all infants and helps prevent transmission during pregnancy and delivery.
These guidelines provide significant opportunities to integrate HBV prevention into existing health programs, including those addressing HIV and other STIs, maternal, newborn, and reproductive health. TDF is already the backbone of HIV treatment and HIV and HBV viral load testing can both be done on the same diagnostic platforms. This means that diagnostic platforms commonly used for hepatitis testing and systems for TDF procurement already have a large global footprint in part due to their use in HIV programs.
Despite this, the upcoming second edition of CHAIs Hepatitis Market Report highlights that the price paid by HBV programs and patients for TDF is more than six times higher in some countries than the price accessed by HIV programs for the same medicine . Similarly, while supplier global pricing agreements for HIV viral load testing also apply to HBV, many countries are still not accessing this pricing.
Abcs Of Hepatitis: Is It Curable
The ABCs of Hepatitis reveal that the disease is either manageable or curable depending on which type of hepatitis a person has. Hepatitis A usually resolves itself within a few months hepatitis B can be suppressed with antiviral drugs until it leaves the body and hepatitis C can be cured outright with medication.
Dr. Aslam advises that preventing the disease is always preferable to curing it after infection, so vaccination for type A and B are important, and avoiding contact with infected people and contaminated body fluids, food, and water will inhibit the spread of all forms of viral hepatitis.
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But Even If You’ve Been Cured It Can Have Lifelong Health Implications
“Hepatitis C is a lot more than just a liver disease,” Reau says. “It has been associated with many medical conditions, such as an increased risk of developing diabetes, kidney disease and cancer.”
While curing hepatitis C significantly reduces the risk of serious complications, like liver failure, liver cancer and the need for transplantation, it doesn’t completely eliminate the health risks associated with the disease.
“Hep C is linked to scarring of the liver or cirrhosis and the more scar tissue that develops, the greater the likelihood of complications,” Reau says. “If there is a lot of scarring, you will need lifelong monitoring.”
Reau also recommends leading a healthy lifestyle to help prevent re-infection and further liver damage: Limit alcohol consumption, control your weight, avoid high-risk activities and manage diabetes if you have it.
What A Hepatitis C Cure Means
Scientists have a very specific definition of what it means to be cured of hepatitis C. In order to be considered cured, patients must have undetectable HCV RNA on an HCV test 12 or 24 weeks after completing a course of therapy. The lack of detectable HCV is what is known as a sustained virological response .
At first, scientists were reluctant to consider an SVR an actual cure. However, research has shown that when HCV RNA is undetectable in both the blood and the liver, the virus has been cured. In theory, this means it may be possible to eliminate all hepatitis C.
More than 95 percent of hepatitis C patients are theoretically curable by an eight- to 12-week treatment regimen with DAAs.
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At Chai We Are Focused On Eliminating Vertical Transmission Which Accounts For Over 50 Percent Of The Global Burden Of Hbv
Clearly, preventing vertical transmission of HBV should be a global priority but we are just as far from achieving an HBV free generation as we were in 2015 when the World Health Assembly member states committed to eliminating the virus. Appropriately, this years World Hepatitis Day theme is Hepatitis Cant Wait, conveying the urgency of efforts needed to eliminate hepatitis as a public health threat by 2030.
At CHAI, we are focused on eliminating vertical transmission, which accounts for over 50 percent of the global burden of HBV. We must act now to prevent infants from being infected if we plan to move toward a generation free of the virus in the next 10 years.
Treatment Of Hepatitis C
Unlike hepatitis A and B, there is no vaccine available for hepatitis C. Fortunately, both acute and chronic hepatitis C infections are curable.
Current hepatitis C treatments involve taking two or more medications known as direct antiviral agents, or DAAs. This combination of medications prevents HCV from replicating until the virus is no longer present in the body. Treatment usually takes 6 to 24 weeks but can take longer.
However, people who have both HIV and HCV need individualized treatments because the medications used to treat HCV infections can interact with HIV treatments.
A doctor will recommend a treatment plan based on the individualâs:
- hepatitis C genotype
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How Is Acute Hepatitis B Treated
Acute hepatitis B doesnt always require treatment. In most cases, a doctor will recommend monitoring your symptoms and getting regular blood tests to determine whether the virus is still in your body.
While you recover, allow your body to rest and drink plenty of fluids to help your body fight off the infection. You can also take an over-the-counter pain reliever, such as ibuprofen , to help with any abdominal pain you have.
See a doctor if your symptoms are severe or seem to be getting worse. You may need to take a prescription antiviral medication to avoid potential liver damage.
Like acute hepatitis B, chronic hepatitis B may not require medical treatment to avoid permanent liver damage. In some patients, monitoring symptoms and getting regular liver tests is appropriate.
Treatment generally involves antiviral medications, such as:
- peginterferon alfa-2a injections
- antiviral tablets, such as tenofovir or entecavir
Antiviral medications can help to reduce symptoms and prevent liver damage. But they rarely completely get rid of the hepatitis B virus. Instead, the goal of treatment is to have the lowest viral load possible. Viral load refers to the amount of a virus in a blood sample.
Theres no cure for hepatitis B, but the condition is easily preventable by taking a few precautions. Hepatitis B is often spread through sexual contact, shared needles, and accidental needle sticks.
You can reduce your risk of developing hepatitis B or spreading the virus to others by: