Effects Of Hiv On The Treatment Of Chronic Hepatitis C
The standard treatment for chronic hepatitis C is PEG-IFN alfa plus ribavirin. Currently, there are two preparations of PEG-IFN alfa: PEG-IFN alfa-2a is given at 180 μg subcutaneously once a week, while PEG-IFN alfa-2b is given at 1.5 μg/kg body weight per week. Ribavirin is given orally at a dose of 800-1200 mg per day, depending on the body weight and HCV genotype. This regimen results in sustained virological response, defined as negative HCV RNA at least 6 months after cessation of therapy, in up to 50% of non-HIV-infected patients infected with HCV genotype 1 and around 80% of patients infected with genotypes 2 and 3. The main limitation of this treatment regime is the side effect profile. The commonest side effects include flu-like symptoms, bone marrow suppression, psychiatric manifestations like depression and anxiety, and autoimmune reactions including thyroiditis.
Syphilis Serological Tests And Experimental Procedures
Samples were screened for syphilis using Accu-Tell® One Step Anti-Treponema pallidum test . This rapid test employs the sandwich principle in detecting antibodies to Treponema pallidum in serum. The test card has a sample well in which Treponema pallidum antigen conjugated with colloidal gold particles has been immobilized. Recombinant Treponema pallidum antigens has been immobilized in the test region and anti-Treponema pallidum antibodies in the control region. On application of the test sample, the anti-Treponema pallidum antibodies bind to the conjugated TP Ag 1 which forms a colored mixture. As the colored mixture migrate chromatographically along the nitrocellulose membrane in the card, if the test sample contains anti- Treponema pallidum antibodies, the antibodies bind to the TP Ag 2 in the test region and a color develops indicating a positive result. No color development is an indication of negative results. As the mixture migrate to the control region the TP Ag 1 in the conjugate binds to the immobilized antibodies in the control region and a color develops. Color development in the control region is an indication that the TP Ag 1/colloidal gold conjugate is potent. Color development at the test and control region is an indication of valid positive results. Color development at the control region alone is an indication of valid negative results however, color development at the test region alone indicates invalid test results.
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
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What Are Hep C Side Effects
Untreated, hepatitis C may cause patients to progress to cirrhosis and possibly liver failure, and/or develop liver cancer, called hepatocellular carcinoma. Hepatitis C is the main reason for adult liver transplantation in the United States. Recently, direct-acting antivirals have become available and are curing over 90% of previously difficult to treat genotype 1 patients. There is also no immunity conferred on patients who are cured, meaning that they may get the virus again if they come in contact with infected blood. There is NO preventative vaccine for hepatitis C.1,2,3
Have questions about symptoms? Community members have answers.
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Test Of Association Of Sexual Lifestyles With Hiv Hbv Hcv And Syphilis Sero
To understand the association of sexual lifestyles and sero-positivity of HIV, HBV, HCV and syphilis, we performed a univariate analysis. Results obtained indicated that heterosexuality was significantly associated with HIV, HBV, HCV and syphilis sero-positivity . In addition, we found out that participants who had regular sex partners were significantly associated with HIV infections. Majority of the study subjects who tested positive for HBV, HCV and syphilis had no history of forced sexual activity such as exchange of sex for money, food, shelter or drugs. However, there was no significant difference in terms of condom usage and infections with HIV, HBV, HCV and syphilis although a greater number of participants admitted to the use of condoms during sex .
Table 4: Association of sexual lifestyles with HIV, HBV, HCV and Syphilis sero-positivity in participants by univariate analysis. View Table 4
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Can We Reduce The Harms Of Crack Smoking
While NSPs are well-established programs for HIV and hepatitis C prevention across Canada, programs that distribute safer crack cocaine smoking equipment are fewer in number and some parts of the country lack these programs altogether. Many safer crack cocaine smoking equipment distribution programs struggle to sustain funding and some have been subject to intense community opposition.35,40,41
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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Hepatitis C Prevention Programmes
Both hepatitis C and HIV are readily transmitted through the sharing of equipment used to inject heroin, crack cocaine and other drugs. Therefore, services use the same approach to prevent transmission of both viruses in people who inject drugs.
should make sufficient quantities of sterile injecting equipment available. Opioid substitution therapy for people with drug dependency reduces the transmission of viral infections because it helps people inject drugs less often. It also helps engage people with healthcare.15
WHO also recommends peer interventions for people who inject drugs.16 Research suggests that combined programmes, rather than singular approaches, are more effective.17
Australia, New Zealand and Western Europe offer integrated hepatitis C, HIV and harm reduction services with promising results, leading to increased access to healthcare among people who use drugs, particularly when programmes involve peer outreach workers.18
Despite the scientific evidence in favour of harm reduction strategies, punitive instead of public health approaches for people who inject drugs are still frequent in many countries. Criminalisation and stigmatisation of people who inject drugs hinders prevention.1920A scale-up of hepatitis C treatment in people who inject drugs would reduce viral loads and make transmission less likely.21
Harm reduction expansion
Natural History Of Hepatitis Co
HBV and HIV
Approximately 350 million people worldwide are infected by HBV. In general, HBV is not directly cytopathic. Damage to hepatocytes is related to host immunological activity against HBV inside the hepatocytes. Among Asian patients who acquire the infection at infancy, the natural history of chronic HBV is divided into three phases. In the immune tolerance phase, there is little host immune response to HBV. This usually occurs during childhood and teenage. The liver enzymes are normal despite high HBV DNA level and positive hepatitis B e-antigen . The immune clearance phase occurs in early adulthood when host immunity starts to clear HBV-infected hepatocytes. This is reflected by elevated liver enzymes and fluctuating HBV DNA. Successful viral suppression is manifested as HBeAg-seroconversion and undetectable HBV DNA. These fortunate individuals would then enter the quiescent phase and have good overall prognosis. In patients who fail to achieve successful viral suppression, chronic or intermittent inflammation of the liver parenchyma may result in cirrhosis and possibly hepatocellular carcinoma.
HCV and HIV
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Treatment For People With Hiv And Hepatitis B Co
In the UK, standards for HIV treatment and care are set and monitored by the British HIV Association , the professional association for HIV doctors and other healthcare professionals. The most recent guidelines on HIV and hepatitis co-infection were produced in 2017 .
“The health of your liver should be regularly monitored during HIV and hepatitis B treatment.”
Like everyone else living with HIV, people with HIV and hepatitis B co-infection are advised to start antiretroviral treatment soon after they are diagnosed with HIV. People with co-infection may particularly benefit from early antiretroviral treatment because undetectable HIV viral load and restored immune function are linked to slower liver disease progression.
Guidelines recommend that all people with HIV and hepatitis B co-infection should use combination antiretroviral therapy containing tenofovir plus either lamivudine or emtricitabine. These drugs are active against both HIV and hepatitis B.
The most widely used option is the Truvada pill combining tenofovir and emtricitabine, along with an additional anti-HIV drug from another class. Fixed-dose combination pills for HIV treatment that contain tenofovir and emtricitabine are also active against hepatitis B. Tenofovir alafenamide is easier on the kidneys and bones than tenofovir disoproxil . People who cannot take tenofovir can use entecavir instead, in addition to combination therapy to treat HIV.
How Are Hepatitis B And C Diagnosed
Hepatitis B is diagnosed by a series of blood tests. The test may show an ongoing infection or antibodies that indicate that the patient is protected against hepatitis B. In patients who have a positive screening test that suggests the possibility of ongoing infection, further testing is done to determine the levels of the virus in the bloodstream.
Hepatitis C is diagnosed via a blood test called a Hepatitis C Antibody Test. A positive result means that hepatitis C antibodies are present in the blood. But a positive antibody test doesnt necessarily mean a person has hepatitis C. A further blood test is needed to confirm the diagnosis. This second blood test quantifies the amount of the virus or the viral load in the liver and the bloodstream.
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What Is Crack Cocaine
Crack cocaine is a stimulant that has been converted from powder cocaine into a rock crystal. When the rock crystal is heated to a high temperature, it melts and quickly vapourizes, and can be inhaled . It produces a short but intense high. Crack is also ranked highly in terms of the harms associated with its use.5
Treatment Of Hepatitis C Virus With Coexisting Hiv Infection
Increased rates of cirrhosis in patients with hepatitis C virus are attributable to various factors, including older age, alcoholism, male sex, and HIV infection higher rates of progression to cirrhosis are seen in patients with HCV/HIV.
HCV infection in patients with HIV infection can have significant consequences, including liver disease progression, liver fibrosis, cirrhosis, increased rates of end-stage liver disease, and shortened lifespan after hepatic decompensation.
Genotype 1 accounts for approximately 75% of hepatitis C infections in the United States.
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Safer Crack Cocaine Smoking Equipment Distribution: Comprehensive Best Practice Guidelines
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People who smoke crack cocaine are at risk of acquiring HIV, hepatitis C and hepatitis B from the physical injuries caused by smoking crack, and also through condomless sex.1,2,3,4 While needle and syringe programs are well established as HIV and hepatitis C prevention programs across Canada, programs that distribute safer crack cocaine smoking equipment are fewer in number some parts of the country lack these programs altogether.
In this article, we address the new evidence-based recommendations for distribution of safer crack cocaine smoking equipment.
Initial Evaluation And Treatment Recommendations For Patients With Hepatitis C Virus/hiv Coinfections
Prior to initiating ART, screen patients with HIV infection for HCV using sensitive immunoassays licensed for the detection of antibody to HCV in blood to confirm the presence of chronic infection, persons who are HCV seropositive should be tested for HCV ribonucleic acid using a qualitative or quantitative assay.
Advise patients with HCV/HIV to avoid alcohol and receive HAV and HBV vaccines, if screened negative via serology.
Drug-induced liver injury following ART is more common in HIV/HCV coinfection eradication of HCV infection may decrease the likelihood of antiretrovirus-associated DILI.
It is important to monitor alanine aminotransferase and aspartate aminotransferase levels at 1 month and then every 3 months after the initiation of ART.
ART should be started in persons co-infected with HCV and HIV in accordance with the recommendations for initiating ART in treatment-naive patients. ART should be started at least 4-6 weeks before hepatitis C treatment is initiated.
The objective of HCV antiviral treatment is to cure the HCV infection, reflected by a sustained virologic response. Although patients with HIV and HCV coinfection traditionally had lower response rates to HCV treatment with older regimen of ribavirin and peginterferon compared to individuals without HIV infection, patients with coinfection appear to have comparable sustained virologic response rates with all oral, direct-acting antiviral combination therapy.
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How To Protect Yourself Against Hepatitis A
There is an effective vaccine against hepatitis A that is recommended for all children at age 1. However, most adults probably have not received it because the vaccine wasnt required when they were young. Dr. Fried says you can come in contact with the hepatitis A infection pretty much anywhere, so its a good idea for everyone older than 1 to get the vaccine, whether or not theyve had any known exposure or traveled to regions where hepatitis A is common.
In addition to getting vaccinated, you should wash your hands every time you go to the bathroom and before handling or serving food or drinks. Also be sure to wash and rinse raw produce before eating or serving it. Cooking raw produce further reduces the risk of infection.
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What Is The Link Between Pipes And Hiv And Hepatitis C Transmission
Pipes for smoking crack cocaine can be crudely constructed from items such as glass bottles, soft drink cans, plastic bottles, car aerials or metal pipes. When makeshift pipes are used to smoke crack cocaine, the hot, jagged surface can cause injuries to the hands and mouth, including oral inflammation, cuts, burns and sores. Blood from these injuries may end up on the pipe. HIV or hepatitis C virus contained in the blood can then be passed along to the next person using the pipe. It is hypothesized that through this mechanism, people who smoke crack cocaine are at an elevated risk of acquiring HIV and hepatitis C.1,2,8,27
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Hepatitis C Treatment Programmes
An important first step to providing treatment for people with hepatitis C and HIV co-infection is to diagnose infections. HIV services should routinely screen all patients for hepatitis C.
However, guidelines recommending screening are often poorly implemented, especially in low and middle-income countries. Hepatitis C testing may not be systematically provided to groups which have elevated rates of hepatitis C, such as people who inject drugs, prisoners, sex workers, and men who have sex with men.43
The Course Of Concurrent Hepatitis B And Hiv Infection
In HIV-positive patients, chronic hepatitis B has an unfavorable evolution compared with patients infected only with HBV, and the associated mortality risk with hepatopathy is significantly increased. In the MACS study , coinfected patients had an associated mortality to liver disease 8 times higher than HIV-positive patients HBsAg negative and 15 times greater than patients negative for both infections. Mortality associated with hepatopathy due to hepatitis B has increased, significantly, since the introduction of the highly active antiretroviral therapy .
In addition to increased mortality, in coinfected patients, HIV accelerates the progression of hepatitis B and increases the risk of cirrhosis significantly. It is important that the clinician is not fooled by the apparent benign course of hepatitis B in HIV patients since this is due to its cellular immunological compromise. Frequently, these patients have only one slight increase in transaminases. However, if HBV-DNA is measured, as a marker of viral replication, this is higher in HIV patients than in patients who are immunocompetent.
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What Is The Connection Between Hiv And Hbv
Both HIV and HBV spread from person to person in semen, blood, or other body fluids. For this reason, the main risk factors for HIV and HBV are the same: having sex without a condom and injection drug use.
According to the Centers for Disease Control and Prevention , approximately 10% of people with HIV in the United States also have HBV. Infection with both HIV and HBV is called HIV/HBV coinfection.
Chronic HBV advances faster to cirrhosis, end-stage liver disease, and liver cancer in people with HIV/HBV coinfection than in people with only HBV infection. But chronic HBV does not appear to cause HIV to advance faster in people with HIV/HBV coinfection.
How Are Hepatitis B And C Treated
Hepatitis B: Not all patients with chronic hepatitis B infection require treatment. At Yale Medicine, specialists decide on an individual basis whether a patient is an appropriate candidate for treatment. Generally, patients require treatment when their hepatitis B virus level is high, and when laboratory tests demonstrate significant inflammation or injury to the liver.
There are currently seven approved drugs for hepatitis B, two of which are considered to be first-line treatments. These drugs are oral pills taken once daily, and while theyre very effective at suppressing the virus to very low or undetectable levels over the long term, they are not considered curative.
Therefore, the goal of treatment is to control the virus long-term and decrease the risk of hepatitis B related complications such as cirrhosis and liver cancer.
Hepatitis C: For the greater part of the last 20 years, treatment of hepatitis C required the use of a chemotherapy-like injection drug called interferon, which has been associated with serious side effects and a low cure rate. Fortunately, advances in hepatitis C treatments within the last three years now allow for the use of oral medications that are significant improvements in terms of safety and effectiveness.
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