Sequence Following An Initial Negative Hepatitis B Surface Antibody Titer
As you obtain documentation, please submit documentation of each step to CastleBranch
- Initial Hepatitis B titer negative for immunity
- Receive Hepatitis B challenge dose/booster
- Repeat Hepatitis B titer 4-6 weeks after challenge/booster vaccine
Hepatitis C Treatment Guidelines
Guidelines issued by WHO in April 2016 recommend four preferred regimens, each including the drug sofosbuvir, in order to simplify treatment decisions for hepatitis C.36 Depending on the regimen, treatment may last 12 or 24 weeks.
When these guidelines were issued, the choice of drug regimen was dependent on which of the six genotypes the patient had. Different genotypes, each with its own genetic composition of the virus, are more common in different parts of the world. Each patient therefore required genotype testing before treatment could be provided.
In July 2018, WHO updated these treatment guidelines to reflect certain key developments. It recommended that the use of DAA regimens for all people with chronic hepatitis C infection, rather than reserving DAA treatment for people with more advanced disease as had previously been done. In part, this is linked to the continued substantial reduction in , which has enabled treatment to be rolled out rapidly in a number of low- and middle-income countries. In addition, as several new pangenotypic DAA medicines have now been approved, the need for genotyping to guide treatment decisions has been reduced.37
Hepatitis B Treatment Outcomes
Effective hepatitis B treatment suppresses hepatitis B virus reproduction, and reducing hepatitis B viral load can reduce inflammation and bring liver enzyme levels back to normal. Less often, treatment can lead to loss of hepatitis B antigens and promote production of antibodies .
The most effective antiviral drugs usually produce low or undetectable hepatitis B viral load in most people who receive treatment. However, people with HBeAg-negative hepatitis B are more likely to respond to treatment. For example, one study found that among HIV-negative people treated with tenofovir, around 95% of HBeAg-negative people and 75% of HBeAg-positive people had undetectable hepatitis B virus DNA after one year. A majority of both groups still had hepatitis B suppression after eight years on treatment.
Most people taking antivirals alone do not experience hepatitis B antigen loss or seroconversion. Pegylated interferon strengthens the immune response against hepatitis B, but usually does not lead to a cure. Some studies show that adding pegylated interferon to antivirals increases the likelihood of these outcomes. For people with co-infection, seroconversion appears to be more likely if they are also on HIV treatment.
There is currently no treatment that cures a majority of people with hepatitis B. Researchers are working on new types of treatment including direct-acting antivirals that attack different steps of the hepatitis B lifecycle and drugs that improve immune response.
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Treatment And Life Expectancy
If HIV develops into stage 3 HIV, life expectancy drops significantly. Its difficult to repair damage to the immune system at this point. Infections and other conditions, such as certain cancers, resulting from severe immune system impairment are common. However, with successful antiretroviral therapy and some immune system recovery, many people with stage 3 HIV live long lives.
With todays treatments for HIV infection, people can live with HIV and never have AIDS develop. Its also important to note that successful antiretroviral treatment and a sustained undetectable viral load greatly lowers the risk of transmitting the virus to a partner.
What Other Problems Can Hepatitis B Cause
In rare cases, acute hepatitis B can cause liver failure.
If you have ever had hepatitis B, the virus may become active again, or reactivated, later in life. This could start to damage the liver and cause symptoms.
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Section : Hiv/hbv Treatment For People Who Use Drugs
Injection drug users are often discriminated against in health-care settings. Often they don’t receive adequate care and are denied medical treatment, even when they need it. Fortunately, this has begun to change. Experience with HIV treatment confirms that it is possible for drug users to adhere to therapy and that they do respond to treatment at rates similar to non-users.
Don’t avoid medical care just because you are using.
Many drug users with HBV are being monitored regularly for disease progression and some have begun, and are staying on, treatment. It is important to find a doctor who is willing and able to work with drug users. Ask other drug users to recommend a doctor — or to warn you about which ones to avoid.
Try hard not to miss medical appointments, since some doctors will use missed appointments as part of the criteria for deciding whether or not they will treat you. Even if you think your treatment side effects are insignificant, discuss them with your doctor and ask up front how he or she plans to help you manage these side effects so you can get through treatment.
If you need pain medication, anti-anxiety drugs, or other medications sometimes associated with “drug use/abuse,” discuss this openly with your doctor before you begin treatment. Be assertive and make an agreement on how the two of you will handle this should the issue arise.
Concerns for People in Recovery
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.
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How Is Hepatitis Treated
Someone who has hepatitis will need to drink enough fluids, eat healthy foods, and get rest. The person’s family members may need to get hepatitis vaccines, if they haven’t already.
Later on, the person will get follow-up blood tests. Often the blood tests will show that the person no longer has hepatitis. Sometimes, the blood tests may show that someone is now a carrier of hepatitis he or she won’t have hepatitis symptoms, but could pass the infection to other people.
Sometimes, blood tests will continue to show that some people still have hep B or C, which means they may have chronic hepatitis. If so, they will need to eat healthy foods and take very good care of themselves by getting rest and visiting the doctor regularly. In some cases, someone with chronic hepatitis may get special medicine for the condition.
We hope that this heads-up on hepatitis will help you stay safe. It may sound funny, but you can love your liver by washing your hands and making smart choices!
Origin Of Antiviral Resistance
The genetic makeup of viruses is constantly changing, which can cause a virus to become resistant to currently available treatments. Viruses can become resistant through spontaneous or intermittent mechanisms throughout the course of an antiviral treatment. Immunocompromised patients, more often than immunocompetent patients, hospitalized with pneumonia are at the highest risk of developing oseltamivir resistance during treatment. Subsequent to exposure to someone else with the flu, those who received oseltamivir for “post-exposure prophylaxis” are also at higher risk of resistance.
Multiple strains of one virus can be present in the body at one time, and some of these strains may contain mutations that cause antiviral resistance. This effect, called the quasispecies model, results in immense variation in any given sample of virus, and gives the opportunity for natural selection to favor viral strains with the highest fitness every time the virus is spread to a new host. Also, recombination, the joining of two different viral variants, and reassortment, the swapping of viral gene segments among viruses in the same cell, play a role in resistance, especially in influenza.
Antiviral resistance has been reported in antivirals for herpes, HIV, hepatitis B and C, and influenza, but antiviral resistance is a possibility for all viruses. Mechanisms of antiviral resistance vary between virus types.
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Section : First Questions
Learning more about hepatitis B will help you better understand the complexities of this condition and become a more informed partner with your doctor in making health-care decisions. Following are some basic questions you might have about HBV and HIV/HBV coinfection. You can find more detailed discussions of these questions in later chapters.
What Is Hepatitis B?
Hepatitis B is a virus that infects liver cells. Once inside the liver, HBV can reproduce in large numbers while causing no liver damage for years to decades. In fact, many people with HBV are healthy and will never need treatment. But in about one out of four people, as they live with the infection longer and by reasons still unclear, their immune system will start to recognize the infection and activate by attacking and killing HBV-infected liver cells, slowly causing liver inflammation and scarring . Eventually, HBV can lead to more serious liver scarring , liver failure, or liver cancer .
How Did I Get HBV?
The good news is that HBV can be prevented. There is an effective preventive vaccine, and the use of condoms and clean drug injection equipment greatly reduces the risk of transmission. For more information about HBV transmission and how to protect yourself and others, see on Transmission and Prevention.
How Serious Is HBV?
The risk of chronic HBV progression varies, based on many factors. People are at higher risk for developing serious disease if they:
How Common Are HBV Infection and HIV/HBV Coinfection?
Appendix: Treatment For Hbv Monoinfection
There are many treatment guidelines published by doctors and researchers advising when to start HBV treatment. There are some minor variations, but they generally recommend treatment for people with a high viral load and elevated ALT levels, and for people with moderate-to-severe fibrosis or any cirrhosis.
Treatment Guidelines Comparison Table
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On the other hand, currently available treatments are highly effective, are generally well tolerated, and have been shown to provide long-term benefits. The pendulum also swings towards favoring treatment when you have other risk factors that can lead to liver damage, such as:
- Being infected for a long time
- Being male over 40-year-old or female over 50-year-old
- Being overweight, and/or drinking a lot of alcohol
- Having a family history of liver disease, abnormal cholesterol, or diabetes and
- Having a weakened immune system people with other conditions that suppress the immune system or people taking immunosuppressive drugs).
Goals of HBV Treatment
There are two types of HBV treatment:
HBV Drug Resistance
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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 2018, 3,322 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 21,600 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 257 million people infected according to the World Health Organization .
Detection Of Antiviral Resistance
National and international surveillance is performed by the CDC to determine effectiveness of the current FDA-approved antiviral flu drugs. Public health officials use this information to make current recommendations about the use of flu antiviral medications. WHO further recommends in-depth epidemiological investigations to control potential transmission of the resistant virus and prevent future progression. As novel treatments and detection techniques to antiviral resistance are enhanced so can the establishment of strategies to combat the inevitable emergence of antiviral resistance.
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Hiv Myth : ‘if Im Hiv
Incorrect. If you get treatment for HIV early on in your pregnancy or continue a treatment regimen, then there is only a very small risk of passing the virus on to your baby about 2%. Without treatment, the risk is about 25%.
All pregnant women should be tested for HIV. Your doctor will determine the best combination of drugs. You should not breastfeed your baby because the virus can also be transmitted through breast milk.
Hepatitis B Vaccine And Surface Antibody Titer Faqs
PLEASE NOTE: This is program specific some programs require 3 Hepatitis B vaccines AND a positive Hepatitis B Surface Antibody titer while others will accept 3 vaccines OR a titer. Please read the information in your CastleBranch account carefully so that you know exactly what you need to meet your programs requirements. If you have any questions, please email and a team member will respond.
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Improving Access For Key Populations
For people from key populations, stigma and structural barriers continue to hinder access to diagnosis, treatment and care for hepatitis C.44 .
To ensure equitable access and engage key populations, clinical services for hepatitis C will need to better adapt their models of care. They may need to provide outreach services, be flexible around appointment requirements, train staff, and consult civil society- and community-led organisations .45
Buyers clubs pool resources to buy DAA medicines via the internet. There are many buyers clubs around the world enabling people to access treatment who would otherwise be unable to receive it. They exist as a stopgap response to the failure of public health systems to ensure equitable access to hepatitis C treatment.
However, there are concerns that compromise other important aspects of treatment, including treatment monitoring and management of co-infection.46
Get Tested Regularly If You Are At Greater Risk Of Hiv
If you are at greater risk of HIV get tested regularly.
Gay, bisexual, trans and other men who have sex with men should get tested every 3 months . This may vary depending on how many sexual partners you have during the year.
Talk with your doctor or sexual health specialist for advice. They can also provide information about how to reduce your risk for HIV and other STIs.
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Hiv Doesnt Always Produce Symptoms
HIV usually causes flu-like symptoms about two to four weeks after transmission. This short period of time is called acute infection. The immune system brings the infection under control, leading to a period of latency.
The immune system cant completely eliminate HIV, but it can control it for a long time. During this latency period, which can last for years, a person with HIV may experience no symptoms at all. Without antiretroviral therapy, however, that person may develop AIDS and as a result will experience many symptoms associated with the condition.
Section : Hbv Disease Progression And The Impact Of Hiv Coinfection
One of the most perplexing aspects of HBV infection is its disease progression. In fact, researchers still don’t fully understand why some people with HBV have no associated health problems, while others progress to serious liver disease however, we do know that HBV disease progression is driven by the immune system’s ability to control HBV replication, and that damages to the liver result from this dynamic process.
HIV worsens HBV because HIV directly attacks the immune system and gradually suppresses immune function by lowering the CD4 cell count. HIV infection also triggers persistent immune activation, which causes low-level inflammation throughout the body. These immune dysfunctions alter HBV disease progression.
Chronic HBV disease progression varies widely among individuals, but in general there are four distinct disease phases. Not everyone will go through every phase, and there can be fluctuations and reversions.
Phase 1: Immune Tolerant
Phase 2: Immune Clearance
Phase 3: Inactive
Phase 4: Reactivation
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Hiv Stigma And Discrimination
HIV can prompt intense feelings in people, regardless of their HIV status. It is sometimes viewed with a sense of unacceptability or disgrace. A person with HIV may feel shame and despair about their status. An HIV-negative person may be fearful or angry when they discover someone has HIV. The relationship of these feelings to HIV is referred to as stigma.Felt stigma refers to deep feelings of shame and self-loathing, and the expectation of discrimination. It can have serious negative impacts on the health and wellbeing of people living with HIV by discouraging them from getting tested, receiving support, or taking treatment. It may also lead people to engage in high-risk behaviours that harm their health, and contribute to new HIV infections.Enacted stigma is the experience of unfair treatment by others. For people living with HIV this can be in the form of being treated differently and poorly, or through rejection, abuse, or discrimination.HIV stigma is particularly harmful when it overlaps with other factors that are stigmatised such as if a person uses drugs, is a sex worker, is trans or gender diverse.Breaking down stigma is a community response where:
If you have experienced stigma or discrimination from a health care provider, and are unable to resolve your complaint with them directly, contact the Health Complaints Commissioner