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.
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.
Treatment Of Hepatitis D Virus
There are currently no treatment options specifically FDA-approved for the treatment of HDV, other than suppressing the HBV infection. Although peginterferon has been recommended the mainstay of therapy for HDV, some data suggest that tenofovir DF can lower HDV RNA levels in a subset of persons with HDV infection. The suppression of HDV RNA levels with tenofovir DF is not reliably sustained and further data are necessary before this is recommended as the main treatment for HDV.
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Stopping Hbv Treatment And Hepatic Flares
In persons receiving treatment with one or more antiviral agent active against HBV, stopping therapy may result in HBV reactivation and potentially serious hepatic inflammation, which is marked by a rise of serum hepatic aminotransferase levels and commonly referred to as a hepatic flaredefined as an ALT increase to at least 3 times greater than the baseline level or ALT greater than 100 U/L. In one study involving 255 individuals with HIV and HBV coinfection, when lamivudine was discontinued, approximately 30% of the participants had increases in ALT levels, 5% had grade 3 or grade 4 elevations, and approximately 1% developed fulminant hepatitis and hepatic decompensation . If a hepatic flare occurs after stopping antiviral therapy, the onset is typically within 6 months after cessation of therapy.
Sharing Body Fluids At A Restaurant
HIV is thehuman immunodeficiency virus. If left untreated, it can lead to Aids, acquired immunodeficiency syndrome. The virus attacks the immune system. People with Aids dont die from the disease they die from ordinary diseases most of us shrug off, because the virus has severely weakened their bodies ability to fight those diseases.
HIV isonly transmitted from one person to another through body fluids such as semen, blood and vaginal fluids.
You wont get HIV by eating at a restaurant unless you share body fluids at that restaurant.
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Hiv And Hbv Coinfection
About 2% of people with HIV in the United States are coinfected with HBV both infections have similar routes of transmission. People with HIV are at greater risk for complications and death from HBV infection. All people with HIV are recommended to be tested for HBV, and if susceptible, are further recommended to receive the hepatitis B vaccination or, if chronically infected, evaluated for treatment to prevent liver disease and liver cancer. For more information about HIV and HBV coinfection, visit HIV.govâs pages about hepatitis B and HIV coinfection.
Acute Hepatitis B Infection
There is no specific treatment for acute hepatitis B, and most people recover within one to two months. Usually, you can manage symptoms at home with painkillers if necessary. Your healthcare professional should advise you to have regular blood tests and physical check-ups. Most people make a full recovery from acute hepatitis B.
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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 .
What Is Hepatitis B
Hepatitis B is a liver infection caused by the hepatitis B virus . The abbreviation HBV can stand for either the virus or the infection it causes.
HBV can be a short-term or a long-term illness:
- Acute HBV occurs within 6 months after a person is exposed to HBV. In some people, acute HBV can lead to chronic HBV.
- Chronic HBV is a lifelong disease. Without treatment, chronic HBV can cause liver cancer or liver damage that leads to liver failure.
HBV is a contagious infection that can spread from person to person.
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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
Covid Kills And Easily Spread In Public Places
Heres how theWorld Health Organization describes Sars-Cov-2 transmission:
Current evidence suggests that the virus spreads mainly between people who are in close contact with each other, typically within 1 metre . A person can be infected when aerosols or droplets containing the virus are inhaled or come directly into contact with the eyes, nose, or mouth.
The virus can also spread in poorly ventilated and/or crowded indoor settings, where people tend to spend longer periods of time. This is because aerosols remain suspended in the air or travel farther than 1 metre .
In a restaurant, you could easily get Covid-19 if the people there are unvaccinated. You are extremely unlikely to get HIV or any type of hepatitis in a restaurant.
The message is misleading without this context.
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How Can I Protect Myself From Hepatitis B
You can protect yourself from hepatitis B with a three-dose vaccination. After the initial vaccination, the second dose is required one month later and the third dose is required five months following the second dose. You can also get a three-dose hepatitis A and B combination vaccination.
Its also a good idea to:
- Use condoms and water-based or silicone-based lube during oral sex and every time when youre fucking
- Use gloves and lube during fisting and change them regularly, especially between partners
- Avoid sharing sex toys or sterilise them completely using disinfectant and a rinse in boiling water
- Avoid oral sex if you or your partner has herpes, ulcers or bleeding gums, as hepatitis B is transmitted through blood and body fluids
- Make sure body artists use new and sterile equipment for tattooing, body piercing and other body art, and ensure they work at premises registered by the local council
- Always use new or sterile needles and syringes. You can find your nearest NSW Needle and Syringe Program Outlet here.
- Avoid sharing needles and syringes or other equipment, such as spoons, swabs or water
- Always wash your hands before and after injecting
- Avoid sharing personal items such as toothbrushes, razors and nail scissors or clippers
What Are The Symptoms Of Hepatitis B
Many people with hepatitis B dont have any symptoms. If you do get symptoms you may not notice them until two or three months after infection and they can last up to three months. There are two types of infection acute and chronic.
Acute symptoms include:
- flu-like symptoms, including tiredness, fever and aches and pains
- feeling and/or being sick
- jaundice, meaning your skin and the whites of your eyes turn yellow
- dark urine
- pale faeces .
People who cant fight off acute infection after six months, such as babies, young children and people with a weakened immune system because of HIV, can go on to develop chronic hepatitis B. This is when people are at higher risk of liver failure, liver disease and cancer of the liver.
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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.
Looking After Your Liver When You Have Hepatitis B
- Drink plenty of fluids.
- Stick to a healthy diet.
- If your skin is itchy keep cool, avoid hot showers and baths and wear loose clothes.
- Avoid alcohol and recreational drugs.
- Attend all your medical appointments and check-ups.
Ibuprofen or paracetamol can help with stomach pain in the acute phase. Check with a clinician if you’re unsure whether you should take them.
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You Can Have It And Not Know It
What is hepatitis B?
Hepatitis B is a liver disease caused by the hepatitis B virus . HBV is far more infectious than HIV and can be prevented by a vaccine. People who have not been vaccinated may be at risk of getting infected.
About 95 percent of adults will recover within 6 months of becoming infected and as a result will develop lifelong protection against it. The remaining 5 percent are unable to clear the virus and will become chronically infected. Chronic hepatitis B infection is treatable.
It is estimated that less than 1 percent of Canada’s population is infected with either acute or chronic HBV. People who are infected before the age of 7 are at a higher risk of developing chronic infection. In 2011, the overall reported rate of acute hepatitis B infection in Canada was 0.6 reported cases per 100,000 people living in Canada.
Why is hepatitis B a health concern?
Many people infected with HBV do not know they have the virus because symptoms can take two to six months to appear and only about 50 percent of people develop symptoms. During this time, they can spread the infection to others. You may not know you have this infection until damage has already been done to your liver. Potential complications from chronic HBV infection include cirrhosis of the liver, liver failure, liver cancer and premature death.
Why do I need my liver?
How is hepatitis B spread?
HBV is spread through contact with infected blood and body fluids including semen and vaginal fluid.
Should People With Hiv Get Tested For Hbv
CDC recommends that all people with HIV get tested for HBV. Testing can detect HBV even when a person has no symptoms of the infection.
There are several HBV blood tests. Results of different tests show different things. For example, a positive hepatitis B surface antigen test result shows that a person has acute or chronic HBV and can spread the virus to others.
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Managing Persons With Coinfection And Advanced Liver Disease
The management of persons with HIV-HBV coinfection who develop cirrhosis and/or end-stage liver disease is the same as in patients with HBV monoinfection and involves close clinical monitoring of serologic markers, surveillance for hepatocellular carcinoma with serial abdominal ultrasounds, screening endoscopy, and management of any cirrhosis-related complications that develop. Liver transplantation is not readily available for many patients with HIV, but has been shown to have favorable outcomes in patients with HIV-HBV coinfection. The management of decompensated cirrhosis or end-stage liver disease in a person with HIV-HBV coinfection should be done by or under the guidance of a hepatologist.
Impact Of Hiv On Natural History Of Hbv
When compared to individuals with HBV monoinfection, those with HBV and HIV coinfection have higher baseline HBV DNA levels, lower alanine aminotransferase levels, and decreased rates of spontaneous hepatitis B e antigen seroconversion. Individuals with HBV and HIV coinfection have an accelerated progression of liver disease, as well as an increased risk of hepatocellular carcinoma, all-cause mortality, and liver-related mortality compared to persons with HIV monoinfection . In one study, investigators reported greater liver-related mortality in persons with HIV and HBV coinfection than observed in either HIV monoinfection or HBV monoinfection . Among those with HIV-HBV coinfection, the highest liver-related mortality rates have occurred in individuals with low CD4 cell counts.
Liver Enzyme Flares In Coinfected Patients Receiving Combination Antiretroviral Therapy
Flares of liver enzymes in HIV-HBV-coinfected patients have a variety of possible causes. In chronic HBV-infected patients who experience HBV suppression while receiving antiretroviral therapy, flares have been reported upon the discontinuation of lamivudine , emtricitabine , or tenofovir treatment or with the emergence of lamivudine resistance . Less likely causes of flares in HIV-HBV-coinfected persons are HBeAg or HBsAg seroconversion or superinfection with another hepatitis virus .
The most common cause of a late flare during combination antiretroviral therapy is the emergence of lamivudine-resistant strains of HBV, which are marked by an increase in HBV DNA and the appearance of the YMDD mutation. Flares that occur after cessation of antiviral therapy have been observed in persons who stop taking lamivudine, emtricitabine, adefovir, or tenofovir .
Risk factors for serious flares after antiviral cessation include elevated transaminase levels at the time that therapy is started and the presence of severe fibrosis. Flares that occur after antiviral therapy has been stopped should be treated by resumption of antiviral treatment, preferably with at least 2 HBV-active drugs in combination.
Epidemiology And Natural History Of Hiv
HIV infection and HBV infection are both sexually transmitted diseases. Coinfections are common globally, because the risk factors for acquisition are the same . In the United States and Europe, > 50% of HIV-infected men who have sex with men have evidence of past HBV infection, and 7%10% have chronic HBV infection, which is defined as the persistence of surface antigen in the serum for at least 6 months. Dual infections may be even more problematic in regions of the world with a high or intermediate prevalence of HBV infection , where early childhood infections and higher rates of chronicity are common.
The global geographic distribution of chronic hepatitis B virus infection and HIV infection. From . HBsAg, hepatitis B surface antigen.
HIV-infected adults who develop acute HBV infection are less likely to eliminate HBV, compared with HIV uninfected adults . There is a decreased likelihood of HBV clearance through a broad cellular response in HIV-infected persons with lower CD4+ T cell counts, compared with HIV-infected persons with higher CD4+ cell counts, at the time of HBV acquisition. In the absence of treatment, HIV-HBV-coinfected patients have higher HBV DNA levels and a longer duration of viremia, but lower transaminase values, compared with patients who are infected only with HBV. This prolonged period of HBV replication may increase horizontal and vertical transmission of HBV in areas of the world with a high prevalence of HIV-HBV coinfection .