Appendix 2: Other viral hepatitis infections

Hepatitis A (HAV)

HAV is found in faeces and can be transmitted when food (including raw or undercooked shellfish) or water are contaminated with sewage, or when an infected person handles food without washing his/her hands after going to the toilet.

Other ways of transmitting HAV include by oral-anal sex (rimming) and from blood transfusions, though this is rare.

Symptoms include: nausea, vomiting, diarrhoea, fever, fatigue, rash, jaundice (yellow skin and eyes), liver pain, and dark brown urine – but some people, especially children, don’t get sick at all.

There is no treatment for HAV, but the symptoms can be treated. It is not a chronic infection.

A person can only be infected with HAV once. HAV goes away by itself, usually within two months.

Hepatitis B (HBV)

HBV is mainly found in blood, semen, and vaginal fluid of infected persons with very small amounts in breast milk and saliva.

HBV can be transmitted by sharing injection or tattooing equipment, from anal or vaginal sex without a condom, from oral sex, and by sharing personal care implements (such as toothbrushes and razors).

Some HBV drugs are also active against HIV, such as: lamivudine (3TC), emtricitibine (FTC), tenofovir and entecavir. HBV can also be treated with interferon and oral antiviral drugs, such as adefovir, and telbuvidine.

As with HIV, antiviral HBV treatment should not be given as monotherapy to people with coinfection. Coinfection guidelines provide detailed information on drug choices. For example, they currently recommend starting HIV treatment earlier, and including tenofovir plus either 3TC or FTC, plus at least one extra HIV drug so that there are at least three active drugs against HIV.

Another important caution is that once HBV treatment is started, unless the infection is completely cleared, HBV treatment should not be stopped. Removing HBV drugs can cause a serious flare of liver enzymes that can be fatal.

If HIV treatment needs to be changed, then the HIV drugs that are active against HBV need to be continued.

Other viral hepatitis infections

There is less research on coinfection with other viral hepatitis infections. These include:

Hepatitis D only occurs in some people with hepatitis B. HDV increases the risk of cirrhosis and the rate of liver disease progression for people with HBV. Vaccination protection against HBV also protects against HDV.

Hepatitis E is similar to hepatitis A. HEV will clear without treatment over several weeks to months. There is no vaccine for HEV. You can only be infected with this virus once. It is not usually serious, except during pregnancy.

Hepatitis G (HGBV-C) is similar to HCV. The importance of hepatitis G is unclear, especially in someone with HIV, but it may not be harmful.