What Is Involved In A Liver Transplant
A liver transplant is considered necessary when the liver is damaged and cannot function or in some cases of liver cancer. Your liver is very important. It is responsible for many functions related to making sure that your body stays healthy and is able to digest foods.
You may be eligible for a transplant if you have chronic hepatitis B infection or some of the diseases that may result from it, including liver cancer and cirrhosis. You will have to complete testing and be evaluated before being approved for a transplant. It is likely that you will be placed on a waiting list while an appropriate organ is found.
Donated livers come from two types of donors: living and deceased. Because the liver can regenerate, it is possible to use part of a liver for transplant. The remaining sections in both the donor and the receiver will grow into livers of adequate size.
People who get liver transplants must take anti-rejection drugs for the rest of their lives. These drugs make you more susceptible to infection. However, liver transplants have become more successful over time and continue to improve.
Management Of Hepatitis Co
Since HBV, HCV and HIV share common routes of transmission, initial assessment of an HIV infected patient should include a detailed history and physical examination looking for symptoms and signs of viral hepatitis and chronic liver disease. Liver function tests should be routinely checked together with viral serology including IgG anti-hepatitis A virus, HBsAg, anti-HBc and anti-HCV. Occult HBV and/or HCV infection is not uncommon in HIV-infected patients. If a patient has negative hepatitis serology but unexplained impairment in liver function, HBV DNA and HCV RNA should be checked as well.
In patients confirmed to have HBV-HIV or HCV-HIV co-infection, further assessment is necessary because the risk of advanced liver disease is increased. Complete blood count should be performed to look for thrombocytopaenia, and ultrasound scan should be arranged to rule out cirrhosis. Liver biopsy should be considered when a decision of treatment needs to be based on the severity of liver fibrosis. This is particularly important for genotype 1 HCV infection which is less likely associated with sustained virological response. Alpha-fetal protein should be performed every 6 months to screen for hepatocellular carcinoma. In patients confirmed to have liver cirrhosis, upper gastrointestinal endoscopy to screen for varices is recommended.
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.
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Treatment Of Hiv Without Treatment Of Hbv
In the highly unusual situation where HIV antiretroviral therapy is indicated, but a decision is made not to initiate therapy for hepatitis B, options exist for treatment of HIV alone. This scenario could arise if significant concerns existed regarding the patient’s adherence, with inconsistent therapy potentially causing hepatitis flares. If the decision is made to proceed with HIV therapy only, the clinician must carefully select a regimen that does not have overlapping anti-hepatitis B activity, such as dolutegravir-rilpivirine. Although this type of selection may be possible, this approach is highly restrictive and prohibits the use of preferred antiretroviral regimens for initial therapy. In addition, data suggest that concurrent treatment of HBV and HIV is indicated to reduce the risk of liver disease progression, a benefit that usually outweighs the risk of HBV-associated flares with treatment interruption. Further, Individuals with HIV and HBV and HCV coinfection should be on a fully suppressive antiretroviral therapy and an HBV active regimen if they are to receive direct-acting antiviral treatment for their HCV, due to the potential risk of HBV reactivation during treatment for HCV.
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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Indications For Hepatocellular Carcinoma Surveillance
In persons with HIV-HBV coinfection, hepatocellular carcinoma usually develops at an earlier age and progresses faster than in persons with HBV monoinfection. Data from populations with HBV monoinfection demonstrate an incidence of hepatocellular carcinoma in chronic HBV of about 0.5% of persons per year and this rate increases to 2.5% per year in persons with cirrhosis. For individuals who have evidence of cirrhosis, including those with HIV-HBV coinfection, screening for hepatocellular carcinoma is strongly recommended. For persons with HIV-HBV coinfection, hepatocellular carcinoma surveillance is indicated in the following groups.
- All persons with cirrhosis
- Asian men older than age 40 years
- Asian women older than age 50 years
- Black men older than 40 years of age
For persons with chronic HBV infection who experience spontaneous or treatment-related clearance of HBsAg, the risk of developing liver disease progression declines considerably as does the risk of hepatocellular carcinoma. The risk of hepatocellular carcinoma, however, is thought to persist, particularly in those who are older than 50 years of age and/or have cirrhosis. There are limited data on the natural history of persons HIV who experience HBsAg clearance. Therefore, these individuals should continue to receive hepatocellular carcinoma surveillance.
Diagnosis Of Hepatitis B In Hiv Infection
It is important to accurately diagnose and assess the state of HBV infection in the HIV-infected individual because therapeutic management is dependent on the correct diagnosis and staging . All patients who are HIV-infected should be screened for hepatitis B with tests for HBsAg, anti-HBs, and antibody to hepatitis B core antigen . Those persons who are negative for anti-HBs and HBsAg are at risk for acquiring HBV and should receive the HBV vaccine. Those who are diagnosed with chronic hepatitis B, as marked by the presence of HBsAg for at least 6 months, should have their disease stage evaluated with testing for HBeAg, antibody to HBeAg , HBV DNA, serum ALT, bilirubin, albumin, prothrombin time, and platelet count.
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Living With Hepatitis B: Your Lifestyle
People living with HIV and hepatitis B can benefit from adopting a healthy lifestyle, including eating a balanced diet. Try to maintain a healthy weight. Being overweight is linked to fatty liver disease which can worsen liver damage.
Since people living with HIV and hepatitis may have an increased risk of cardiovascular disease and diabetes, your clinic should regularly monitor your blood fats or lipids and blood sugar .
People living with hepatitis B should limit how much alcohol they drink, and those with liver damage should avoid alcohol altogether. Not smoking and cutting down or stopping recreational drug use are also important for overall health.
- Eat a balanced diet including vegetables, fruit and wholegrains.
- Get regular moderate exercise.
Is There A Cure For Chronic Hepatitis B
Currently, there is no complete cure for hepatitis B. But when managed properly, those living with the virus can expect to live a normal life. Maintaining a healthy diet and avoiding alcoholic beverages and tobacco products are crucial components in managing the disease.
You should also visit a doctor familiar with hepatitis B at least annuallythough twice a year might be best to monitor your liver through blood tests and medical imaging. As with most diseases, detecting it early leads to a better outcome. If youre exposed to the virus, you should get an antibody injection within 12 hours of exposure.
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Effects Of Hiv On The Treatment Of Chronic Hepatitis B
At present, interferon-alpha, pegylated interferon-alpha , lamivudine and adefovir dipivoxil are registered for the treatment of chronic hepatitis B in Hong Kong. These agents have been extensively investigated, but literature on their use in HBV-HIV co-infected patients is relatively scarce.
Oral nucleoside analogues suppress HBV replication by inhibiting the DNA polymerase. As HBV replication involves reverse transcription as in the case of HIV, a number of registered and investigational drugs for HBV treatment have been used in the treatment of HIV before. Lamivudine is given at a dose of 150 mg twice daily for HIV and 100 mg once daily for HBV treatment. In HBV-HIV co-infected patients, the early response to lamivudine is satisfactory. In a cohort of 40 patients with HBV-HIV co-infection, lamivudine treatment at 300 mg per day resulted in HBeAg seroconversion in 19%, a figure that was comparable to that of patients without HIV infection. The main problem of long-term lamivudine therapy is the almost inevitable emergence of drug-resistant mutants at the tyrosine-methionine-aspartate-aspartate motif of the HBV polymerase gene . In HBV-HIV co-infected patients receiving lamivudine, YMDD mutants emerge at a rate of 20% per year and reach 90% by 4 years. This mutation rate is higher than that in patients infected with HBV alone.
What Are The Types Of Hepatitis B
There are two types of hepatitis B infection: acute and chronic.
An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.
If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.
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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.
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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Difference Between Hepatitis B And Hiv
Hepatitis is a disease, affecting the liver which can be caused by several viral entities such as A, B, C, D and E. This condition, in general, is defined as an inflammation of the liver which can either be self-limiting in nature or complicates to fibrosis, scarring, liver cirrhosis or malignancy.
On the other hand, HIV is a virus which invades the human immune system and weakens the immunity of the individual, thus increasing the susceptibility to infections, inflammatory conditions and various other illnesses in the body.
Both Hepatitis and HIV can cause similar signs and symptoms, yet HIV tends to affect the overall body rather than being limited just to the liver.
Hepatitis B, if properly managed can be cured completely.
HIV doesnt have any permanent cure at all except for the treatment with Antiretroviral drugs which is known to control the spread and reduce the incidence of transmitting the disease from infected person to another.
Hepatitis B virus v2 By Original uploader was TimVickers at en.wikipedia via Commons Wikimedia
Symptoms of AIDS By Medical gallery of Mikael Häggström 2014. WikiJournal of Medicine 1 . DOI:10.15347/wjm/2014.008. ISSN 20018762. via Commons Wikimedia
Management Of Hiv Virologic Failure
If an individual with HIV-HBV coinfection experiences HIV virologic failure, but continues to have adequate HBV suppression on the regimen, then the antiretroviral medications that are active against HBV should be continued and given in combination with additional antiretroviral medications that are chosen based on HIV drug resistance genotypic testing.
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What Is The Treatment For Individuals With Hiv And Hepatitis
Doctors primarily treat HIV with antiretroviral therapy. This effective treatment helps stop HIV from progressing to a later stage disease called AIDS.
With the exception of HAV, most hepatitis infections are treated with medications called antivirals. Treating HBV and HCV early is important in preventing liver diseases and cancers, some of which may be fatal.
HCV is treated with antiviral medications taken over the course of 8 to 12 weeks. The HHS says that this treatment has a 97 percent cure rate, including in people with HIV.
While HBV is also treatable, medications work to suppress the virus. They cant get rid of it entirely. Similar to HIV, treatment for HBV may be lifelong.
HAV is an acute infection. It can resolve on its own, or it can last up to 6 months, according to the . Rest and fluids are standard treatments, but more severe cases may require hospitalization.
HIV-hepatitis coinfections are treatable when detected early, according to the HHS.
Some people may take separate medications for HIV and hepatitis, like in the case of HCV. However, you can sometimes treat both viruses at the same time with the same medications. It may be helpful to find a doctor whos also experienced with treating both viruses.
Risk factors for contracting HIV or hepatitis may include:
- sharing needles, razors, or syringes
- having sex without a condom or other type of barrier method
- transmission during childbirth
How Is Hepatitis B Diagnosed
There are three main ways to diagnose HBV infection. They include:
- Blood tests: Tests of the blood serum shows how your bodys immune system is responding to the virus. A blood test can also tell you if you are immune to HBV.
- Abdominal ultrasound: An ultrasound uses sound waves to show the size and shape of your liver and how well the blood flows through it.
- Liver biopsy: A small sample of your liver tissue is removed though a tiny incision and sent to a lab for analysis.
The blood test that is used to diagnose hepatitis B is not a test that you get routinely during a medical visit. Often, people whove become infected first learn they have hepatitis B when they go to donate blood. Blood donations are routinely scanned for the infection.
The virus can be detected within 30 to 60 days of infection. About 70% of adults with hepatitis B develop symptoms, which tend to appear an average of 90 days after initial exposure to the virus.
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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.
How Many People Have Hepatitis B
In the United States, an estimated 862,000 people were chronically infected with HBV in 2016. New cases of HBV infection in the United States had been decreasing until 2012. Since that time, reported cases of acute hepatitis B have been fluctuating around 3,000 cases per year. In 2019, 3,192 cases of acute hepatitis B were reported however, because of low case detection and reporting, the Centers for Disease Control and Prevention estimates that there were 20,700 acute hepatitis B infections. New HBV infections are likely linked to the ongoing opioid crisis in the United States.
Globally, HBV is the most common blood-borne infection with an estimated 296 million people infected according to the World Health Organization .
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