When To Initiate Therapy
Decisions regarding when to initiate anti-HBV therapy require consideration of the HIV treatment status because several of the nucleoside analogs are active against both HIV and HBV. If HIV infection needs to be treated, then the first-line therapy for HIV includes tenofovir disoproxil fumarate and emtricitabine as the nucleoside backbone. Because both of these agents are active against HBV, HBV is treated simultaneously by default.
If HIV is not treated, a decision regarding whether to initiate anti-HBV therapy is required. The current recommendations are to weigh both the replication status of HBV as well as the stage of liver disease to guide treatment decisions. There are inadequate data in HIV-HBV coinfection to determine the appropriate cutoff value for HBV DNA levels for treatment initiation, but many experts recommend a level of 2000 IU/mL . The liver disease stage is best obtained by a liver biopsy because serum aminotransferase levels tend to be low in patients with HIV infection, even in the presence of cirrhosis. The presence of more than mild liver disease is an indication for treatment. As described above, noninvasive markers of liver disease have not been well studied in HIV infection thus, they cannot be reliably used to determine liver disease stage. In patients with cirrhosis, treatment is recommended in the presence of any detectable HBV DNA.
What Therapy To Start When Haart Does Not Need To Be Started
If HIV treatment is not initiated, anti-HBV treatment options are more limited due to the dual activity of many nucleoside analogs and the risk of developing drug-resistant HIV. The only current options are adefovir, peginterferon-alfa, and telbivudine. Of the three agents, telbivudine is the most potent, but it is limited by development of drug-resistant HBV in the monoinfected patient. Although telbivudine has not been studied in vivo in the setting of high levels of HIV RNA, in vitro evidence suggests that it is not active against HIV. In a single-round replication assay, telbivudine did not affect HIV replication . Peginterferon-alfa has the advantage that drug-resistant HBV will not emerge, so it is a reasonable option if the patient can tolerate the injections and the side effects. It is possible that a combination of one or more of these three agents may be effective in this situation, but it has not been studied. Thus, each of these approaches to anti-HBV therapy in HIV-infected individuals who do not receive concurrent HAART therapy is suboptimal. For these reasons, an additional option is to initiate HAART earlier than is required by HIV guidelines. Early initiation of HAART may be an increasingly attractive option, especially because HIV increases the rate of liver disease progression and earlier HIV treatment is now being advocated even in HIV monoinfection.
Sport And Transmission Of Hiv And Hepatitis
The risk of transmission of HIV or hepatitis B or C from an infected player is:
- negligible for other athletes and players involved in contact sports
- negligible for first aid officers who follow infection control guidelines
- zero for coaches, trainers, officials and spectators.
HIV and hepatitis B and C cannot spread through:
- sweat or saliva from other sportspeople
- sharing drink bottles with team members
- hugging or shaking hands.
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Epidemiology Of Blood Contact
To understand the nature, frequency, and prevention of percutaneous injuries and mucocutaneous blood contacts among HCWs, prospective observational studies have been performed in different patient care settings .1). The percentage of procedures with at least one blood contact of any type ranged from 3% of procedures performed by invasive radiology personnel in a study in Dallas, Tex. , to 50% of procedures performed by surgeons in a study in Milwaukee, Wisc. . The percentage of procedures with at least one injury caused by a sharp instrument also varied widely, from 0.1 to 15%. These differences may be related to variations in study methods, procedures observed, and precautions used by the workers performing the procedures.
Prevention Of Hiv Infection
At present, there is no effective HIV vaccine to prevent HIV infection or slow the progression of AIDS in people who are already infected. However, treating people who have HIV infection reduces the risk of their transmitting the infection to other people.
Transmission of HIV through its most common routessexual contact or sharing of needlesis almost completely preventable. However, the measures required for preventionsexual abstinence or consistent condom use Prevention Sexually transmitted diseases are infections that are typically, but not exclusively, passed from person to person through sexual contact. Sexually transmitted diseases may be caused… read more and access to clean needlesare sometimes personally or socially unpopular. Many people have difficulty changing their addictive or sexual behaviors, so they continue to put themselves at risk of HIV infection. Also, safe sex practices are not foolproof. For example, condoms can leak or break.
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How Hiv And Hepatitis B And C Are Spread
HIV damages the immune system and can cause acquired immune deficiency syndrome if untreated. Hepatitis B and C are viruses that can cause serious damage to the liver. To become infected with HIV or hepatitis B or C while playing sports, body fluids such as blood from an infected person would need to enter your bloodstream through:
- a significant abrasion on your skin
- a bleeding wound
- your mucous membranes .
HIV and hepatitis B are spread in similar ways. Because both HIV and hepatitis B are found in blood, semen and vaginal fluids, these infections are transmitted:
- from mother to baby during childbirth or breastfeeding.
HIV cannot be transmitted by a person who is on treatment and who has low levels of virus in their body . In other words, there is no risk of HIV transmission through exposure to blood during sport from a person has an undetectable viral load.
Hepatitis C is spread through blood-to-blood transmission only, but is not thought to be sexually transmitted unless blood is present.
Hbv Serotypes And Genotypes
Based on some of the antigenic determinants of HBsAg, nine serological types -referred to as subtypesadw2, adw4,adrq+, adrq, ayw1,ayw2, ayw3, ayw4 andayr – have been identified . Ten genotypes of HBV have been identified, and thesecorrespond to specific geographic distributions . Genotype A is more frequently found in North America,northwestern Europe, India, and Africa. Genotypes B and C are endemic to Asia,and genotype D predominates in eastern Europe and the Mediterranean . Type E is found in western Africa typeF, in South America and type G, in France, Germany, Central America, Mexico,and the United States. Type H is prevalent in Central America type I, in Vietnam and type J, in Japan .
HIV-seropositive MSM populations predominantly coinfected with HBV genotype Ahave been reported in European countries and Japan ,,. The prevalence of HBV genotype A issignificantly higher in the MSM population than in the rest of the population. In addition, Araujo etal. speculated in their review that HBV subgenotypes A2 and C arelikely to predominate in populations at high risk of infection via sexualtransmission . Additionally, HBVgenotype A develops into a persistent infection more often than genotype C ,.
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Hiv Treatment And Prevention
Simple, effective treatments for HIV are widely available in Australia. In addition to protecting the health and wellbeing of people living with HIV, these treatments significantly reduce the risk of HIV transmission. Almost all people on HIV treatments have very low levels of virus in their body. This is called having an undetectable viral load. There is no risk of HIV transmission from a person with an undetectable viral load. This is sometimes referred to as undetectable equals untransmissible, or U=U.
For people who do not have HIV, but may be at higher risk of it, affordable medication is available that is more than 99 per cent effective at preventing HIV. Known as PrEP , this medication is available through the Pharmaceutical Benefits Scheme from your regular GP.
How Does Hbv Spread From Person To Person
HBV is spread through contact with the blood, semen, or other body fluid of a person who has HBV. Among adults in the United States, HBV is spread mainly through sexual contact.
HBV can also spread from person to person in the following ways:
- From contact with the blood or open sores of a person who has HBV
- From an accidental prick or cut from an HBV-contaminated needle or other sharp object
- From a mother who has HBV to her child during childbirth
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Government Of Canada’s Role
The Government of Canada works collaboratively with provincial and territorial authorities to monitor HBV across the country. The Public Health Agency of Canada has produced The Canadian Guidelines on Sexually Transmitted Infections which includes recommendations on the management of HBV. The latest edition of the Canadian Immunization Guide also includes recommendations for HBV immunization.
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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Pathogenesis Of Liver Disease
It seems paradoxical that HBV-related liver disease, which is an immune-mediated process, is exacerbated by the immunodeficient state caused by HIV. There are several possible reasons for this paradoxical relationship. In HIV-infected persons, a rapidly progressive form of liver disease due to viral cytopathic effect rather than the immune response, which is known as fibrosing cholestatic hepatitis, has been described. Thus, it is plausible that HBV variants, which can be more common in HIV infection, may account for a proportion of the increased liver disease in HIV coinfection., In support of this hypothesis, Revill et al. described a novel deletion mutation in the precore/core region of the HBV genome and found it to be more common among HIV-HBV coinfected than HBV monoinfected individuals. Coinfected persons with this mutation had higher HBV DNA levels than those without the mutation. In HBV monoinfected patients, core deletion mutations have been associated with more aggressive liver disease thus, this novel deletion mutant may contribute to liver disease progression in the setting of HIV infection.
It has also been hypothesized that HIV modulation of the HBV-specific immune response can alter the hepatic cytokine environment and subsequently affect liver disease. However, this hypothesis has not been studied to date.
How Are Hepatitis B And Hepatitis C Spread From Person To Person
Like HIV, the hepatitis B and hepatitis C viruses spread:
- From mother to child: Pregnant women can pass these infections to their infants. HIV-HCV coinfection increases the risk of passing on hepatitis C to the baby.
- Sexually: Both viruses can also be transmitted sexually, but HBV is much more likely than HCV to be transmitted sexually. Sexual transmission of HCV is most likely to happen among gay and bisexual men who are living with HIV.
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Strategies For Preventing The Transmission Of Hiv
Condoms made of latex provide good protection against HIV , but they are not foolproof. Oil-based lubricants should not be used because they may dissolve latex, reducing the condom’s effectiveness.
Other measures can help. For men, circumcision, an inexpensive, safe procedure, reduces the risk of becoming infected during vaginal intercourse with an infected woman by about half. Whether circumcision reduces the risk of HIV infection in other circumstances is unclear. Because circumcision provides only partial protection against HIV infection, people should also use other measures to prevent HIV infection. For example, if either partner has a sexually transmitted disease or HIV infection, it should be treated, and condoms should be used correctly and consistently.
Screening And Diagnostic Tests
If doctors suspect exposure to HIV infection, they do a screening test for HIV. Doctors also recommend that all adults and adolescents, particularly pregnant women, have a screening test regardless of what their risk appears to be. Anyone who is concerned about being infected with HIV can request to be tested. Such testing is confidential and often free of charge.
The current combination screening test tests for two things that suggest HIV infection:
Antibodies are proteins produced by the immune system to help defend the body against a particular attack, such as that by HIV. Antigens are foreign substances that can trigger an immune response.
The body takes several weeks to produce enough antibodies to be detected by the test, so results of the antibody test are negative during the first few weeks after the virus enters the body . However, results of the p24 antigen test can be positive as early as 2 weeks after the initial infection. The combination tests can be done quickly by a laboratory. Also, a version of these tests can be done in a doctor’s office or clinic . If results are positive, doctors do a test to distinguish HIV-1 from HIV-2 and a test to detect the amount of HIV RNA in the blood .
Other, older rapid bedside tests are also available. These tests can be done using a sample of blood or saliva. If results of these rapid screening tests are positive, they are confirmed by ELISA or by repetition of one or more other rapid tests.
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Characteristics Of The Included Studies
A total of 4022 records were obtained by electronic and manual search . After removing duplicate records, 2562 records remained for further assessment. We excluded 2057 studies after screening titles and/or abstracts. We read 505 studies and during the full-text review, 453 articles were excluded for different reasons . In the end, 52 eligible articles were included in our qualitative synthesis and the quantitative meta-analysis . The characteristics of the studies included in this review are presented in Table .
Of the 52 included studies, 48 were cross-sectional and 4 were prospective cohort studies . Of all, 50 studies reported HCV infection and 23 studies reported either solely HBV infection or both HBV and HCV infections . Regarding the study location, 21 studies were conducted in Europe , 18 were conducted in America , 2 in South-East Asia , 7 in East Mediterranean , 3 in Western Pacific , and 1 in Africa region .
Preventive Treatment After Exposure
People who have been exposed to HIV from a blood splash, needlestick, or sexual contact may reduce the chance of infection by taking antiretroviral drugs for 4 weeks. These drugs are more effective when they are started as soon as possible after the exposure. Taking two or more drugs is currently recommended.
Doctors and the person who was exposed typically decide together whether to use these preventive drugs. They base the decision on the estimated risk of infection and the possible side effects of the drugs. If they do not know whether the source is infected with HIV, they consider how likely the source is to be infected. However, even when the source of the exposure is known to be infected with HIV, the risk of infection after exposure varies, depending on the type of exposure. For example, risk from a blood splash is less than that from a needlestick.
Immediately after exposure to HIV infection, what is done depends on the type of exposure:
If skin is exposed, it is cleaned with soap and water.
Puncture wounds are cleaned with antiseptic.
If mucous membranes are exposed, they are flushed with large amounts of water.
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Preventing Transmission By Blood Transfusions And Organ Transplants
In the United States, the following have almost eliminated transmission of HIV infection by organ transplantation or blood transfusion:
Screening donors of organs or blood for risk factors for HIV infection
Screening donated blood for HIV
Risk is reduced further by asking people with risk factors for HIV infection, regardless of their test results for HIV, not to donate blood or organs for transplantation.
However, developing countries have not consistently used sensitive HIV screening tests and have not restricted donors. Consequently, transmission by these routes is still a problem in these countries.
How Does Drug Use Affect Symptoms And Outcomes Of A Viral Infection
Drug use can worsen the progression of HIV and its symptoms, especially in the brain. Studies show that drugs can make it easier for HIV to enter the brain and cause greater nerve cell injury and problems with thinking, learning, and memory. Drug and alcohol use can also directly damage the liver, increasing risk for chronic liver disease and cancer among those infected with HBV or HCV.
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