Recommendations For Patients With Hbv/hiv Coinfection
- All patients with chronic HBV should be evaluated to assess the severity of HBV infection . Patients with chronic HBV should also be tested for immunity to hepatitis A virus infection and, if nonimmune, receive the HAV vaccination. In addition, patients with chronic HBV should be advised to abstain from alcohol and counseled on prevention methods that protect against both HBV and HIV transmission.15
- Before ART is initiated, all persons who test positive for hepatitis B surface antigen should be tested for HBV DNA by using a quantitative assay to determine the level of HBV replication , and the test should be repeated every 3 to 6 months to ensure effective HBV suppression. The goal of HBV therapy with nucleoside reverse transcriptase inhibitors is to prevent liver disease complications by sustained suppression of HBV replication.
- Since HBV reactivation has been observed in persons with HBV infection during interferon-free HCV treatment,16,17 persons with HCV/HIV coinfection and active HBV infection should receive ART that includes agents with anti-HBV activity prior to initiating HCV therapy . The diagnosis of HBV reactivation should be considered in persons with current HBV infection who experience elevated liver enzymes during or immediately after HCV therapy.
What Treatments Are Available For Viral Hepatitis
Many medications are available for the treatment of chronic HBV and HCV infection. For chronic HBV infection, there are several antiviral drugs. People who are chronically infected with HBV require consistent medical monitoring to ensure that the medications are keeping the virus in check and that the disease is not progressing to liver damage or cancer.
There are also antiviral medications available for HCV treatment and new treatments have been approved in recent years. Many antiviral HCV treatments can cure more than 90 percent of people who take them within 8 to 12 weeks. HCV treatment dramatically reduces deaths, and people who are cured are much less likely to develop cirrhosis or liver cancer. However, not everyone infected with HCV needs or can benefit from treatment. NIDA researchers have identified genes that are associated with spontaneous clearance of HCV. These genes also enable people who are unable to clear HCV on their own to respond more favorably to treatment medications. This new information can be used to determine which patients can benefit most from HCV treatment. More studies must be done, but this is a first step to personalized medicine for the treatment of HCV.
How Do I Know If I Am Infected With Viral Hepatitis
The number of new HBV and HCV infections has been declining in recent years, but the number of people living with chronic hepatitis infections is considerable, and deaths associated with untreated, chronic hepatitis infections have been on the rise. This is because most people dont know they are infected until the disease has begun to damage the liver, highlighting why screening for viral hepatitis is so important. People with a history of drug use are generally at higher risk, and should discuss their substance use with their health care provider.
Initial screening for HBV or HCV involves antibody tests, which show whether you have been exposed to the hepatitis virus, although not necessarily whether you are still infected. A positive antibody test should then be followed up with a test that measures the amount of virus in your blood. If this follow-up test is positive, then you should seek advice from a physician that specializes in viral hepatitis treatment. Because screening for hepatitis is so critical for linking people who test positive to the care they need, NIDA is studying new rapid HCV antibody tests that can be used in drug treatment settings.
The CDC recommends that people who inject drugs be tested for hepatitis B and C as part of routine medical care. To determine if you are at risk for contracting hepatitis, HHS has created an online assessment tool to help you find out.
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Antiviral Medication For Hepatitis C
For people with hepatitis C, the goal of treatment with antiviral medication is to prevent the virus from replicating, or copying itself, and to eliminate the virus from the bloodstream. If the hepatitis C virus has been in the body for more than six months, the infection is considered chronic. Without treatment, most people with acute hepatitis C develop the chronic form of the disease.
Your doctor decides which antiviral medicationor combination of medicationsto prescribe based on the results of a blood test called a genotype test. There are six genotypes, or strains, of the hepatitis C virus, and people with certain genotypes respond more quickly to medical treatment.
For many years, the standard treatment for chronic hepatitis C consisted of the antiviral medications pegylated interferon and ribavirin. Ribavirin is taken by mouth every day, and interferon is an injection that you or a caregiver can administer once a week at home.
In 2013 and 2014, the U.S. Food and Drug Administration approved a group of new medications for the treatment of hepatitis C. These medications, which include sofosbuvir, are very effective and have fewer side effects than older medications, particularly interferon.
What Treatments Are Available For Chronic Hepatitis B
Hepatitis B treatment is based on the results of blood tests, age, and the degree of scarring in the liver. Hepatitis B treatment is recommended for patients with very active virus and an inflamed liver. People with chronic hepatitis B and cirrhosis also may be candidates for treatment.
Treatment involves taking an oral antiviral medication. In some cases, injections may be used.
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Preferred Initial Hbv Therapy
When initiating treatment for chronic HBV, the recommended approach, in most circumstances, is to use a potent oral antiviral that has a high genetic barrier to resistance, typically with long-term administration of the medication. Three oral antivirals are recommended as a preferred option for initial therapy: entecavir, tenofovir alafenamide, or tenofovir DF. For most individuals undergoing treatment for chronic HBV, any one of these three agents can be used. Some special situations, as outlined below, warrant preference of one of these agents over another. Combination therapy, including use of two oral antivirals, one antiviral plus peginterferon, or two antiviral is not recommended for initial treatment.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children and pets. Store it at room temperature and away from excess heat, light, and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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How Is It Transmitted
Hepatitis B is highly infectious, and is spread from one person to another through exposure to infected blood and body fluids . It can be spread through:
- blood transfusions or organ transplantation in countries where blood or blood products have not been properly screened for hepatitis B and other viruses transmitted through blood
- unprotected sex with an infected person
- sharing needles or equipment for injecting drugs
- unsterilized medical/dental equipment and shared/contaminated materials or equipment used for tattooing, body piercing or acupuncture
- sharing toothbrushes or razors
- household contact between family members
Why Is This Medication Prescribed
Entecavir is used to treat chronic hepatitis B infection in adults and children 2 years of age and older who have liver damage. Entecavir is in a class of medications called nucleoside analogs. It works by decreasing the amount of hepatitis B virus in the body. Entecavir does not cure HBV and may not prevent complications of chronic hepatitis B such as cirrhosis of the liver or liver cancer. Entecavir does not prevent the spread of HBV to other people.
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How Should This Medicine Be Used
Entecavir comes as a tablet and solution to take by mouth. It is usually taken once a day on an empty stomach, at least 2 hours after a meal and at least 2 hours before the next meal. Take entecavir at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take entecavir exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
What Are The Other Health Challenges For People With Hepatitis Who Inject Drugs
People with hepatitis who inject drugs often have several other health conditions at the same time, including mental illness and HIV/AIDS, thus requiring care from multiple health care providers. This is sometimes referred to as co-occurring disorders. Substance use disorder treatment is critical for PWID, as it can reduce risky behaviors that increase the chance of transmitting hepatitis. Research has shown that patients with hepatitis receiving medication-assisted treatment for their opioid addiction can be safely treated with antiviral medications.5
To enhance HCV care, NIDA is examining coordinated care models that utilize case managers to integrate HCV specialty care with primary care, substance use disorder treatment, and mental health services so that these patients get treatment regimens that address all of their health care needs. The Health Resources and Services Administrations Ryan White HIV/AIDS Program developed a free, online curriculum about HIV/hepatitis C for healthcare providers and healthcare staff to increase knowledge about co-infection among people of color in the United States.
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Evaluation Of Hepatitis B Virus Dna
HBV extracellular DNA and core-associated DNA were isolated as described previously with minor modifications . Briefly, the culture supernatant was treated with DNase at 37°C for 30 min, and extracellular DNA was extracted by a QIAmp DNA Mini Kit according to the manufacturers protocol. For isolation of core-DNA, the cells were lysed in lysis buffer . After removal of the nuclear pellet by centrifugation, the supernatant was treated with 20 U/ml DNase , 5 µg/ml RNase , 5mM MgCl2 and 5mM CaCl2 at 37°C for 3 h to degrade the nucleic acids outside the nucleocapsids. The DNase was then inactivated by the addition of 10 mM EDTA. After the inactivation of DNase, proteinase K , sodium dodecyl sulfate and NaCl were added to disrupt the nucleocapsids. Finally, core-DNA was isolated by a QIAmp DNA Mini Kit . The amounts of extracellular DNA and core-DNA were measured by real-time PCR using Fast SYBR Green Mater Mix with the HBs-specific primers. The thermal profile was as follows: 40 cycles of 95°C for 1 s and 60°C for 20s.
What Is My Risk
Your risk depends of several factors: destination, length of stay, what you do when you are travelling and whether you have direct contact with blood or other body fluids. In certain destinations, your risk may be higher, as some areas have higher numbers of people with chronic hepatitis B in the general population.
The risk increases with certain activities, such as unprotected sex, sharing needles, tattooing and acupuncture.
Aid and health care workers and anyone who receives medical or dental care with unsterilized or contaminated equipment in a country where hepatitis B occurs are also at greater risk.
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Hepatitis B Causes And Risk Factors
Itâs caused by the hepatitis B virus, and it can spread from person to person in certain ways. You can spread the hepatitis B virus even if you donât feel sick.
The most common ways to get hepatitis B include:
- Sex. You can get it if you have unprotected sex with someone who has it and your partnerâs blood, saliva, semen, or vaginal secretions enter your body.
- Sharing needles. The virus spreads easily via needles and syringes contaminated with infected blood.
- Accidental needle sticks.Health care workers and anyone else who comes in contact with human blood can get it this way.
- Mother to child.Pregnant women with hepatitis B can pass it to their babies during childbirth. But thereâs a vaccine to prevent newborns from becoming infected.
Question 2 Effectiveness Of Antiviral Therapy In Patients With Immune
Two studies, evaluated antiviral therapy in HBeAg-positive patients with normal ALT levels. Detailed study characteristics and risk of bias are described in Tables and .
One RCT compared tenofovir to a combination of tenofovir and emtricitabine for 192 weeks. Although no long-term clinical outcomes were reported, tenofovir and emtricitabine versus tenofovir showed a statistically significant increase in viral suppression but no statistically significant increase in HBeAg loss , HBeAg seroconversion , or HBsAg clearance . The quality of evidence was low due to indirectness and imprecision.
In a cohort study of 68 HBeAg-positive postpartum women, pegylated IFN and adefovir versus untreated control significantly improved rates of HBeAg seroconversion and HBeAg loss . The quality of evidence was very low, down-rated due to the observational nature of the study, risk of bias, and imprecision.
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Whats The Prognosis For Hepatitis B
Your doctor will know youâve recovered when you no longer have symptoms and blood tests show:
- Your liver is working normally.
- You have hepatitis B surface antibody.
But some people don’t get rid of the infection. If you have it for more than 6 months, youâre whatâs called a carrier, even if you donât have symptoms. This means you can give the disease to someone else through:
- Unprotected sex
Practical Management Of Drug Resistance
In cases of a confirmed virological breakthrough and exclusion of non-adherence , the patient should be either switched to another antiviral monotherapy with a high genetic barrier to resistance or a second antiviral drug with a complementary resistance profile should be added . Although it appears reasonable from a virological point to reduce resistance by combination therapy, there are no clear long-term data favoring the add-on over the switch concept . Table 2 summarizes current recommendations for the management of treatment failure.
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Antiviral Medication For Hepatitis B
Doctors may recommend antiviral medication for people with chronic hepatitis B, which occurs when the virus stays in your body for more than six months.
Antiviral medication prevents the virus from replicating, or creating copies of itself, and may prevent progressive liver damage. Currently available medications can treat hepatitis B with a low risk of serious side effects.
NYU Langone hepatologists and infectious disease specialists prescribe medication when they have determined that without treatment, the hepatitis B virus is very likely to damage the liver over time. People with chronic hepatitis B may need to take antiviral medication for the rest of their lives to prevent liver damage.
There are many different types of antiviral medications available, and your doctor recommends the right type for you based on your symptoms, your overall health, and the results of diagnostic tests. A doctor may take a wait-and-see approach with a person who has a healthy liver and whose blood tests indicate a low viral load, the number of copies of the hepatitis B virus in your bloodstream.
Someone with HIV infection or AIDS may have a weakened immune system and is therefore more likely to develop liver damage. The U.S. Centers for Disease Control and Prevention strongly recommends that people with HIV infection who are diagnosed with hepatitis B immediately begin treatment with antiviral medication.
Medical Treatment For Hepatitis A B & C
Treatment for hepatitis A, B, or C is based on which type of hepatitis is present in the bloodstream and the severity of the resulting liver damage. Depending on the results of diagnostic tests, our specialists at NYU Langone may recommend antiviral medication to stop the virus from replicating and protect your liver from further damage.
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Approved Drugs For Adults
There are currently 7 approved drugs in the United States for adults living with chronic hepatitis B infection. These include 5 types of antiviral drugs that are taken as a pill once a day for 1 year or longer. And there are 2 types of immune modulator drugs called interferon that are given as an injection for 6 months to 1 year.
It is important to know that not everyone needs to be treated. A liver specialist should evaluate your health through a physical exam, blood tests, and an imaging study of your liver . Then you can discuss together whether you are a good candidate for treatment since the approved drugs are most effective when there are signs of active liver disease. In addition, talk to your provider about HBV Clinical Trials since there are several new drugs being tested that are available for infected adults.
All adults, however, should be seen regularly by a liver specialist whether they are on treatment or not.
What Do I Need To Know About Having Hepatitis B
If you have chronic hepatitis B, getting the right medical care can help you stay healthy. Taking good care of your liver is important. Talk with your doctor before you take any prescription medication, over-the-counter drugs, vitamins, or nutritional supplements to make sure they wont hurt your liver. You should also stay away from alcohol, because drinking can damage your liver.
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