Hcv: On The Path Toward Elimination
Since the isolation of hepatitis C virus in 1989, strategies to eradicate the virus have evolved rapidly. Interferon was the first drug used to treat the infection and, with addition of ribavirin, SVR rates around 5456% were achieved . The real revolution came with the advent of DAAs: treatments of shorter duration achieved SVR rates above 95% for nearly all patient groups. However problems come from reinfection that can occur even after a successful treatment . Reinfection among PWID and MSM due to ongoing risk behaviour could compromise both individual and population treatment benefit . Modeling studies conducted in North America among PWID showed that treatment with DAAs offered a high chance for HCV elimination at an attainable cost if implemented in combination with increased access to HCV testing and harm reduction . Another study based on theoretical model projections showed that in Greece chronic hepatitis C could be eliminated in the next 45 years by increasing treatment to more than 16% of PWID per year in combination with moderate increases in harm reduction coverage .
How Is Hepatitis B Prevented
Testing & Vaccination
- The hepatitis B vaccine offers excellent protection against HBV. The vaccine is safe and highly effective. Vaccination consists of 3 doses of vaccine over the course of 6 months. Protection lasts for 20 years to life.
- The American Academy of Pediatrics recommends that all children should receive hepatitis B vaccine starting at birth. .
- The CDC recommends hepatitis B vaccine for persons traveling to countries where HBV is common .
- If you have one or more risk factors for hepatitis B infection, you should get a simple HBV blood test. The blood test will determine whether you are:
- immune to hepatitis B or
- susceptible to hepatitis B and need vaccination or
- infected with hepatitis B and need further evaluation by a physician
- California law requires testing of all pregnant women for hepatitis B infection
- If the mother is HBV-infected, she will pass the infection to the baby during the birth process, unless the baby gets immunized within hours of birth
- Giving the infant HBIG and HBV vaccine right away will reliably prevent infection of the infant
- Other family members should best tested for hepatitis B too, and given vaccine if they are not already infected or immune
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Hepatitis C In Patients With Hiv Increases Age
The association between increasing age and risk for type 1 myocardial infarction in patients with HIV is more significant among those with vs without hepatitis C virus coinfection, suggesting that HCV status should be considered when evaluating cardiovascular disease risk in this patient population. These study findings were published in The Journal of the American Heart Association.
Researchers sought to determine whether patients with HIV and HCV coinfection were at increased risk CVD, as well as the influence of age on this risk.
Data for the study were sourced between January 2000 and December 2017 from the North American AIDS Cohort Collaboration on Research and Design. Patients included in the study were aged between 40 and 79 years and had received antiretroviral therapy for at least the previous 3 months.
The primary outcome was the incidence of type 1 MI between patients with vs without HCV coinfection.
Researchers found that incident type 1 MI occurred among 89 patients with HCV coinfection and 314 of those with HIV alone .
After adjustments for covariates, an increased risk for type 1 MI was observed for every 10-year increase in age among all patients . An increased risk for type 1 MI also was observed among patients with diabetes , those who were smokers , and those who used protease inhibitors . Of note, the risk for type 1 MI was significantly increased among patients with hypertension .
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People With Both Hiv And Hepatitis B May Receive Better Care
People with HIV are at greater risk for hepatitis B but are less likely to get vaccinated and respond to vaccines.
Less than 10% of HIV-positive people are adequately vaccinated against hepatitis B virus despite being more vulnerable, according to research presented at this years Conference on Retroviruses and Opportunistic Infections . At the same time, another study found that people living with both HIV and HBV received better care than people with hepatitis B alone.
Over years or decades, chronic hepatitis B can lead to severe liver disease, including cirrhosis, liver cancer and the need for a liver transplant. Between 5% and 10% of people living with HIV in the United States also have chronic hepatitis B, according to federal HIV treatment guidelines. People with HIV and HBV coinfection are at increased risk for liver complications compared to those with either virus alone.
Most people with hepatitis B recover without treatment, gain immunity and do not get it again. But around 5% of those who acquired HBV as adults develop chronic infection, a figure that is higher for people living with HIV. Certain antiretroviral medications used to treat HIV are also active against HBV: lamivudine , emtricitabine , tenofovir disoproxil fumarate and tenofovir alafenamide . These drugs are components of several combination pills used for HIV treatment or pre-exposure prophylaxis .
Hepatitis B Care
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.
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Treating Hepatitis C Together With Hiv
If youre HIV positive and have hepatitis C infection, then you must receive care from a doctor skilled in the treatment of both HIV and hepatitis.
Due to the new direct-acting antiviral drugs, people living with HIV and hepatitis C co-infection can be treated with most of the same hepatitis C drug regimens as HIV-negative people. Research has shown that cure rates are the same.
Unlike treatment for HIV, hepatitis C treatment is not for life. New drugs to treat hepatitis C only need to be taken for up to 3 months.
Is Hepatitis Testing Recommended For People With Hiv
Yes. Everyone living with HIV should be tested for HBV and HCV when they are first diagnosed with HIV and begin treatment. People living with HIV who have ongoing risk factors for getting hepatitis B or hepatitis C should be tested annually.
In addition, new HCV screening recommendations from the Centers for Disease Control and Prevention call for:
- One-time screening for all adults 18 years and older
- Screening of all pregnant women during every pregnancy
- Testing for all persons with risk factors, with testing continued periodic testing those with ongoing risk.
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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
Subject Inclusion And Data Collection
During each structure/half day visit, a number of DUs corresponding to the calculated sample size were asked to participate and included if they consented to the interview and self fingerprick blood sampling on dried blood spots for HIV and HCV testing. The questionnaire was administered over 30 to 40 minutes by professional interviewers independent of the recruitment structures.
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Hbv Infection: Chronic But Preventable Disease
Current treatment strategies do not allow complete viral eradication in HBV infection. Peg-IFN has significant side effects, but it is able to achieve a functional cure in a number of patients and remains a possible therapeutic option . Lifelong nucleoside analog therapy, on the other hand, has few side effects but achieves functional cure only in a small minority of patients .
What makes hepatitis B infection really different from HIV and HCV is the availability of an effective vaccination since the early 1980s. A long-term study of 14 years conducted in The Gambia showed a high effectiveness of vaccination against chronic carriage and new infection among children and young people at different ages . To date, 183 of the 193 WHO member states have initiated an hepatitis B vaccination program . Approximately 84% of children worldwide received three doses of hepatitis B vaccine and are thus probably protected from HBV infection for life. The additional administration of hepatitis B immune globulin at birth can further reduce the risk of MTCT in high-risk deliveries .
Hiv: On Our Way To Global Control
Considering its high effectiveness, the WHO and UNAIDS have recommended Treatment as Prevention for HIV to be widely implemented . It has been demonstrated that effective treatment suppresses the viral load, and this correlates with a significantly decreased chance of transmission to uninfected individuals . The landmark HIV Prevention Trials Network published a landmark trial in 2011, showing that treating HIV-infected individuals from a discordant couple was 96% effective in preventing HIV infection of their partner . In addition, no linked infections were observed when HIV was successfully undetectable by ART . A more recent study conducted within Danish men who have sex with men demonstrated that TasP could contribute to HIV epidemic elimination when the treatment coverage and viral load suppression rate are high . Finally, these observations were confirmed by the large Partner-1 and -2 studies again clearly demonstrating no HIV transmissions when there is an undetectable viral load after nearly 77,000 acts of condomless sex.
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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.
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.
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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.
How Is Hepatitis B Transmitted
Hepatitis B is spread in several distinct ways: sexual contact sharing needles, syringes, or other drug-injection equipment or from mother-to-child at birth.
In the United States, in 2018, injection drug use was the most common risk factor reported among people with an acute HBV infection, followed by having multiple sex partners. Less commonly reported risk factors included accidental needle sticks, surgery, transfusions, and household contact with a person with HBV infection. In the United States, healthcare-related transmission of HBV is rare.
Mother-to-child transmission of HBV is especially concerning, because it is preventable. An estimated 25,000 infants are born to mothers diagnosed with HBV each year in the United States, and approximately 1,000 mothers transmit HBV to their infants. Without appropriate medical care and vaccinations, 90% of HBV-infected newborns will develop chronic infection, remaining infected throughout their lives. Up to 25% of people infected at birth will die prematurely of HBV-related causes. For this reason, the standard of care for pregnant women includes an HBV test during each pregnancy so that the appropriate steps can be taken to prevent HBV-positive mothers from transmitting the disease to her infant.
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How Do You Get Hepatitis B
sharing toothbrushes and razors
sharing needles for shooting drugs, piercings, tattoos, etc.
getting stuck with a needle that has the Hep B virus on it.
Hepatitis B can also be passed to babies during birth if their mother has it.
Hepatitis B isnt spread through saliva , so you CANT get hepatitis B from sharing food or drinks or using the same fork or spoon. Hepatitis B is also not spread through kissing, hugging, holding hands, coughing, sneezing, or breastfeeding.
Diagnosing Hepatitis C In People Living With Hiv
Everyone with HIV should be tested to see if they also have hepatitis C. A blood test for antibodies to hepatitis C is used to see whether you have been exposed to the virus. You might be given a PCR test to confirm infection.
In people living with HIV, the diagnosis of hepatitis C can be more difficult, as the infection may not show up on their antibody tests.
If you think you may be at risk of hepatitis C infection, you should have regular tests to see if you have been infected with the virus.
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Getting The Conversation Started
Theres still a stigma around STDs and HIV that can make them embarrassing or difficult to talk about. But theres no shame in taking steps to protect yourself and your sexual partners.
Talking with a doctor and any partners doesnt have to be uncomfortable. Here are a few tips on where to start:
- Bringing up STDs with a medical professional during a general visit about other health concerns can make it easier to start the conversation.
- Asking questions about any steps you should be taking for your sexual health is a good way to start the conversation about safe sex and STDs.
- Using a leading question like, Ive recently started dating again and wanted to ask a few questions about safe sex, during your appointment might make you feel more comfortable.
- Emphasizing to partners that youre concerned about their safety, as well as your own, can lead to more productive conversations.
Lack Of Trained Healthcare Providers
Healthcare professionals in sport such as first aid providers and team doctors are at particular risk of blood borne infections because they treat bleeding injuries. During sports training sessions in developing countries, there may be no healthcare professional available, as was typically the situation in the United Kingdom in the past for less professional teams and clubs, where coaches and/or other athletes have routinely performed first aid treatment. In such situations, coaches and athletes are at risk of blood borne infections in the same way as healthcare professionals. Moreover, they may be at more risk because of their more limited knowledge and skills. Bourliere et al reported a case of hepatitis C infection as a result of sharing a handkerchief to dry bleeding wounds after a bloody fisticuffs. This example of transmission could occur in the sports setting when the first aider is not an expert. Therefore all coaches and athletes should be educated about first aid, infection control, and hygiene.
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