Hepatitis B And Hiv Combo May Promote Liver Cancer
Need for early diagnosis
The study, to be published shortly, involved patients from cancer units. The results showed that the age profile of liver cancer patients was affected by HIV. Liver cancer in Africans occurs at a young age: between the ages of 30 and 40 years. But we found that it occurs at a significantly younger age in those who are infected with HIV and hepatitis B.
Liver cancer is the third most common cause of death among the seven million people who die from cancer annually across the globe.
Early death from liver cancer could be reduced if HIV-positive people were more rigorously screened for hepatitis B.
Diagnosing hepatitis B in HIV-infected people is important because it is treatable. But it often goes undiagnosed. Second, hepatitis B appears to be more aggressive in HIV as viral loads are higher and it is more difficult to clear. The rates of liver cancer may be higher and the risk of onward transmission is greater.
Our study is significant because it highlights the need for early diagnosis of hepatitis B. Screening for the infection is not currently taking place and, as a result, patients are presenting with cancer at a young age, with a late-stage malignancy that could be prevented.
Tackling hepatitis B
A dedicated approach
Use Caution With Tattooing
Licensed businesses that offer tattooing or body piercing are generally thought to be safe from hepatitis C. But getting a tattoo, piercing, or even acupuncture can lead to hepatitis C infection if the equipment was not properly sterilized.
If you choose to get a tattoo or piercing, find out if the business has a valid permit or license. If you receive acupuncture, ask to see your practitioners acupuncture license.
Sexually transmitted hepatitis C is not common, but its possible. If you have sex with someone who has the virus, certain behaviors can increase your risk. These include:
- practicing sex without a condom or other barrier method
- having more than one sexual partner
Treatment Of Hepatitis B Virus With Coexisting Hiv Infection
Patients with HIV infection are at a greater risk for hepatitis B virus infection, due to the common route of transmission.
Treatment of HIV infection may improve the virologic, histologic, and clinical evolution of chronic HBV infection.
Several antiretroviral agents, such as emtricitabine , lamivudine , and tenofovir, have activity against HIV and HBV, whereasile others, such as entecavir, have limited activity against HIV but lead to the development of HIV-resistant strains if used alone.
Prior to the initiation of ART, all patients who test positive for hepatitis B surface antigen should be tested for hepatitis B virus deoxyribonucleic acid using a quantitative assay to determine the level of HBV replication.
Chronic HBV is defined as testing positive for HBsAg on 2 occasions for more than 6 months patients with chronic HBV infection already receiving ART active against HBV should undergo quantitative HBV DNA testing every 6-12 months.
Routine screening and immunization are recommended for all patients infected with HIV to prevent primary HBV infection however, the immune response to HBV vaccine is lower in patients with HIV infection than in uninfected patients, and postvaccination HBsAg must be tested to document immunity.
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Special Considerations For Antiretroviral Therapy In Patients With Hepatitis C Virus/hiv Coinfection
Special considerations for ART in patients coinfected with hepatitis C virus and HIV include the following:
Use caution with antiretroviral agents with the greatest risk of DILI .
Assess patients with cirrhosis for signs of liver decompensation according to the Child-Turcotte-Pugh classification system hepatically metabolized antiretroviral drugs may require dose modification or avoidance in patients with Child-Pugh class B and C disease.
Treatment of both HCV and HIV can be complicated by drug interactions, drug toxicities, and pill burden. Many of the newer directly acting anti-HCV drugs have significant interactions with antiretroviral agents however, ledipasvir with sofosbuvir and daclatasvir plus sofosbuvir have been demonstrated as efficacious.
Regimen selection for HCV infection can vary based on genotype, history of prior HCV treatment, stage of underlying liver fibrosis, and, in rare cases, the presence of baseline NS5A inhibitor resistanceassociated substitutions.
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:
- telbivudine .
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Preventing Hepatitis C Infection
Here’s how you can protect yourself against hepatitis C:
- Do not share needles, syringes or any other equipment to inject drugs.
- Use latex gloves for fisting, with a new glove with each partner.
- Do not share pots of lubricant.
- Do not share sex toys, or put a new condom on the sex toy each time you use it.
- Properly used condoms provide excellent protection against the transmission of HIV, hepatitis C and other sexually transmitted infections.
- A caesarean delivery can reduce the risk of mother-to-child transmission of the virus.
Theres no vaccine for hepatitis C. Unlike hepatitis A and B, having hepatitis C once doesnt mean youre then immune from getting it again. Its possible to be reinfected with the hepatitis C virus.
Protecting Against Hiv And Hepatitis Off The Field
It is important to practise safer sex when off the field by using condoms and water or silicone-based lubricant to protect yourself from HIV, hepatitis B and other sexually transmissible infections.
People who inject steroids or other performance enhancing drugs are at risk of HIV, and both hepatitis B and C, if they share needles, syringes or any injecting equipment such as swabs or tourniquets. Injecting equipment should be used once only and never shared.
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What’s The Relationship Between Drug Use And Viral Infections
People who engage in drug use or high-risk behaviors associated with drug use put themselves at risk for contracting or transmitting viral infections such as human immunodeficiency virus , acquired immune deficiency syndrome , or hepatitis. This is because viruses spread through blood or other body fluids. It happens primarily in two ways: when people inject drugs and share needles or other drug equipment and when drugs impair judgment and people have unprotected sex with an infected partner. This can happen with both men and women.
Drug use and addiction have been inseparably linked with HIV/AIDS since AIDS was first identified as a disease. According to the CDC, one in 10 HIV diagnoses occur among people who inject drugs.1 In 2016, injection drug use contributed to nearly 20 percent of recorded HIV cases among menmore than 150,000 patients. Among females, 21 percent of HIV cases were attributed to IDU.2 Additionally, women who become infected with a virus can pass it to their baby during pregnancy, regardless of their drug use. They can also pass HIV to the baby through breastmilk.
Aids 2022 Spotlights A Game
Thursday, 28 July 2022, 6:40 amPress Release: International AIDS Society
Studies highlighted at the 24th International AIDSConference provide insights on new and existing strategiesto help end the HIV epidemic.
27 July 2022 New studies presented atAIDS 2022, the 24thInternational AIDS Conference, hosted by IAS theInternational AIDS Society demonstrate promisingadvances in the global HIV response.
Speaking at avirtual press conference, authorsshared:
- Successful results from a trial of theantibiotic doxycycline to prevent sexually transmittedinfections
- Reports of two adults in long-termremission off antiretroviral therapy
- A newmethod using microfluidics to define a biomarker of the HIVreservoir
- News of Botswana surpassing global95-95-95 targets to nearly eradicate the epidemic in thecountry
- Promising results of a triple-therapyregimen for people living with both HIV and hepatitisB
A cure remains the Holy Grail of HIVresearch, Sharon Lewin, IAS President-Elect and Directorof The Peter Doherty Institute for Infection and Immunity,said. We have seen a handful of individual cure casesbefore, and the two presented today provide continued hopefor people living with HIV and inspiration for thescientific community. Whats more, we are now seeing anadvance in the great challenge of finding a biomarker forthe HIV reservoir a truly excitingdevelopment.
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Whats The Outlook For People Who Have Hiv And Hepatitis
HIV-hepatitis coinfections are treatable, but there are differences in the overall outlook depending on the severity and type.
For example, HCV may be cured within months, while HBV often requires lifelong treatment. If youre living with HIV, youll also need lifelong treatment for HIV, too. Complications may include cirrhosis or liver cancer.
Theres no medication available for HAV infections. If youre living with HIV and receive an HAV diagnosis, your doctor will monitor your condition carefully for complications, such as liver failure.
With treatment, HIV can become undetectable. When the virus is undetectable, it cant be transmitted to other people.
If youre living with HIV without a current hepatitis infection, your doctor may recommend regular testing to help detect hepatitis early on, depending on your risk factors. The earlier hepatitis is diagnosed and treated, the better the outcome.
Detection Of Hiv1/2 Antibody
Plasma samples were screened for antibodies against HIV1/2 following the national serial rapid HIV testing algorithm and the WHOs guidelines on HIV testing and counseling strategy.20,21 Accordingly, three commercially available rapid tests were used in the following order: Wantai , Uni-GoldTM , and Vikia . According to the HIV testing algorithm, to declare a person HIV positive, he/she should be positive with at least two tests. The sensitivity and specificity of each rapid test are summarized in the Supplementary Table 1.
Briefly, plasma samples that tested positive with the first test were subjected to the second test , and those found positive with the second test too considered positive for HIV1/2 antibodies. Likewise, those samples positive with the first test and negative with the second test were tested with the third test , and samples that turned positive were considered positive for HIV1/2 antibodies. Results from each test were interpreted as per the manufacturers instruction.
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Factors Associated With Hiv And Hiv/hbv Co
Among the risk factors, age , gender , tattoo , marital status , province , clinical status , and chronic consumption of alcoholic beverages significantly associated with the rate of HIV infection . Of the risk factors, only age exhibited a significant association with HIV/HBV co-infection frequency. About 55% and 14% of chronic liver disease patients were chronic consumers of alcohol and cigarette smokers, respectively. Consequently, chronic alcohol consumption and smoking showed a marginal association with HCC than non-HCC cases . Compared with non-HCC, older age exhibited a significant association with HCC cases .
Table 3 Factors Associated with Human Immunodeficiency Virus Infection
Figure 2 Trend of HIV and co-HIV/HBV infection across the different age groups of chronic liver disease patients in Ethiopia.
Can Hcv Infection Be Prevented
The best protection against HCV is to never inject drugs. If you do inject drugs, always use new, sterile needles, and do not reuse or share needles, syringes, or other injection drug equipment.
People, including people with HIV, can also take the following steps to reduce their risk of HCV infection:
- Do not share toothbrushes, razors, or other personal items that may come in contact with another personâs blood.
- If you get a tattoo or body piercing, make sure the instruments used are sterile.
- Use condoms during sex. The risk of HCV infection through sexual contact is low, but the risk increases in people with HIV. Condoms also reduce the risk of HIV transmission and infection with other sexually transmitted diseases, such as gonorrhea and syphilis.
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Can Hbv Infection Be Prevented
Yes. The best way to prevent HBV is to get the hepatitis B vaccine.
CDC recommends that people with HIV and people who are at risk for HIV get the HBV vaccine . The housemates and sexual partners of people with HBV should get the HBV vaccine, too.
People, including people with HIV, can also take the following steps to reduce their risk of HBV infection:
- Use condoms during sex to reduce the risk of HBV infection and infection with other sexually transmitted diseases, such as gonorrhea and syphilis.
- Do not inject drugs. But if you do, do not share needles, syringes, or other drug injection equipment.
- Do not share toothbrushes, razors, or other personal items that may come in contact with another person’s blood.
- If you get a tattoo or body piercing, make sure the instruments used are sterile.
How Does Drug Use Affect Symptoms And Outcomes Of A Viral Infection
Drug use can worsen the progression of HIV and its symptoms, especially in the brain. Studies show that drugs can make it easier for HIV to enter the brain and cause greater nerve cell injury and problems with thinking, learning, and memory. Drug and alcohol use can also directly damage the liver, increasing risk for chronic liver disease and cancer among those infected with HBV or HCV.
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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.
Protecting Everyone Involved In Sport Against Hiv And Hepatitis
Consult your sporting organisations infection control policies. Simple and inexpensive procedures can prevent the spread of HIV, hepatitis B and C, including:
- Remember to cover all pre-existing wounds before starting a game.
- Wear protective gloves when giving first aid to bleeding players.
- If someones eyes have been splashed with blood with the eyes open, rinse the area gently but thoroughly with water or normal saline, rinsing away from the nose.
- If blood gets in your mouth spit it out and rinse your mouth with water several times.
- Standard practice is to stop play if a player is bleeding and allow them to return to play only after bleeding is controlled and the wound is properly covered.
- Bandage any wounds that occur, and properly clean any playing surfaces and change any clothes exposed to blood before play restarts.
- Have your own drink bottle and towel, mouth guard and other personal items, including razors, to reduce the possibility of small amounts of blood-to-blood transmission.
- If you are concerned about potential infection, contact a doctor or health information line for further advice.
If a player is injured while playing sport:
- Remember to wear protective gloves when giving first aid to a player who is bleeding.
- Stop the bleeding from the wound.
- Dress the wound.
- Clean up the blood.
Treatment Recommendations For Tuberculosis And Hiv Infection
Tuberculosis is caused by Mycobacterium tuberculosis, which commonly affects the lungs, although it can also affect other parts of the body.
Patients with HIV infection are more likely to be affected by TB HIV infection may increase the risk for progression from latent to active TB. The risk for TB begins in the first year following HIV infection. TB infection can occur at any CD4 cell count, though the risk increases with progressive immunodeficiency.
All patients should be tested for latent TB infection at the time of HIV diagnosis and annually using skin testing or interferon-gamma release assay .
Patients diagnosed with active TB should be started on TB treatment as soon as possible recommendations for anti-TB treatment regimens in adults infected with HIV follow the same principles as recommendations for adults without HIV infection. Standard anti-TB regimens include isoniazid plus a rifamycin plus pyrazinamide plus ethambutol for 2 months, followed by isoniazid plus a rifamycin for 4-7 months.
Weekly isoniazid plus rifapentine for 3 months is now recommended as an alternative regimen for LTBI when provided as directly observed or self-administered therapy. Patients with LTBI who cannot receive isoniazid should receive daily rifampin monotherapy for 4 months.
The timing of ART and anti-TB therapy must therefore be taken into consideration, as follows :