Hepatitis is a name for any infection that causes liver inflammation or damage.<\/strong><\/p>\n Three main causes of liver infection are viral\u00a0hepatitis A (HAV)<\/strong>, hepatitis B (HBV)<\/strong> and hepatitis C (HCV)<\/strong>. These are\u00a0different<\/strong> viruses with different treatments.<\/p>\n This section mainly deals with HBV<\/strong>\u00a0and HCV.<\/strong><\/p>\n HBV is acquired sexually including through saliva.<\/p>\n HCV\u00a0is acquired by blood contact through infected needles or during sex. Sexual transmission is generally a low risk for heterosexual sex. Sexual transmisson is a higher risk for HIV positive gay men.<\/p>\n HBV an HCV are considered coinfections<\/strong> rather than OIs<\/strong>.<\/p>\n Some symptoms of acute (early) or active liver infection are similar for any viral liver infection.<\/strong><\/p>\n These symptoms include nausea, vomiting, fatigue, diarrhoea, jaundice (yellow eyes or skin).<\/p>\n Not everyone will get symptoms or even know they are infected. Intolerance to fatty foods or alcohol, a swollen or tender liver or ‘liver spots’ on the skin are other symptoms of hepatitis.<\/p>\n HBV\u00a0can be transmitted by sexual exposure including oral sex and sharing injecting drug equipment. HBV\u00a0is more infectious than HIV.<\/strong><\/p>\n Up to 90% of people living with HIV have already been exposed to HBV. Most people clear HBV without treatment.<\/p>\n HIV seems to make HBV a more serious illness. Some common HIV drugs\u00a0also treat HBV and this can complicate treatment for HIV\/HBV coinfection.<\/p>\n Blood tests for HBV can test for either previous exposure<\/strong> or active infection<\/strong>.<\/p>\n The symptoms listed above should prompt a doctor to test for HBV.<\/p>\n Viral load (PCR) tests for hepatitis are used similar to HIV viral load tests. These tests can confirm an infection when immune-based tests are either negative or unclear.<\/p>\n If HBV is cleared, you are usually immune to reinfection in the future.<\/p>\n HIV and HBV coinfection needs care from a doctor with experience of both infections.<\/p>\n Several drugs used to treat HIV also are active against HBV.<\/p>\n These drugs include 3TC<\/strong>, FTC<\/strong>,\u00a0tenofovir DF<\/strong>\u00a0and TAF<\/strong>.<\/p>\n HBV monoinfection is also treated with adefovir<\/strong>, a drug developed for HIV, but now used just for HBV.<\/p>\n All these drugs have to be used very carefully in someone with both HIV and HVB infections.<\/p>\n Interferon was an early injected treatment for HBV. This is now used less often because tablets are easier to tolerate.<\/p>\n HBV can be successfully treated in many people. Sometimes life-long treatment is needed. Long-term HBV coinfection is a specialist area of disease management.<\/p>\n If HBV is cleared, you are usually immune to reinfection.<\/p>\n Effective vaccinations are available for hepatitis A and hepatitis B.<\/strong><\/p>\n Response to vaccines are related to CD4 count. Depending on the vaccine and CD4 count, higher doses in HIV positive patients are sometimes recommended. (See BHIVA 2015 guidelines on vaccination<\/a>).<\/p>\n There is no vaccination against hepatitis C.<\/p>\n Research into new drugs to treat hepatitis B is ongoing.<\/strong><\/p>\n Some of these drugs will be available in the next few years. The aim for new HBV drugs is to produce a higher rate of cures.<\/p>\n Direct acting antivirals (DAAs) are highly effective oral drugs to treat HCV.<\/strong><\/p>\n DAAs work just as well for people living with HIV, and annual HCV testing is now recommended. Although DAAs can have a high cure rate you can still be reinfected again in the future.<\/p>\n The choice of DAAs with depend on country you live in and how much HCV has damaged your liver.<\/p>\n However, in many countries, HCV is still diagnosed late, often after years of infection.<\/p>\n Blood tests can screen for either previous exposure to HCV\u00a0or active infection.<\/strong><\/p>\n Many people clear the virus without knowing they were infected, and produced antibodies. The symptoms listed above should prompt a doctor to test for HCV.<\/p>\n Viral load (PCR) tests used for hepatitis are similar to HIV viral load tests, and can confirm an infection when immune-based tests are either negative or unclear.<\/p>\n If you are diagnosed with HCV, then you might have an HCV genotype test<\/strong> to find out which type of HCV you have (genotype 1, 2, 3, 4, 5 or 6). This is not needed if you are being treated with DAAs that cover all genotypes.<\/p>\n HIV and hepatitis C coinfection needs to involve\u00a0a doctor with experience of both infections.<\/strong><\/p>\n DAAs are highly effective with a short course of treatment and have few side effects. However, these drugs are also expensive in most countries.<\/p>\n Older treatment with\u00a0PEG interferon <\/strong>plus ribavirin<\/strong>\u00a0or early HCV protease inhibitors should no longer be used.<\/p>\n There is no vaccination against hepatitis C.<\/strong><\/p>\n Effective vaccinations are available for hepatitis A and hepatitis B.<\/p>\n New HCV drugs are still being developed in different settings.<\/strong><\/p>\n Other areas of research include:<\/p>\n EACS guidelines (2022)<\/a><\/strong> – Section IV hepatitis coinfection,<\/p>\n Recently acquired and early chronic hepatitis C in MSM:<\/strong><\/a> Recommendations from the European treatment network for HIV, hepatitis and global infectious diseases consensus panel. AIDS. 2020 Oct 1;34(12):1699-1711. doi: 10.1097\/QAD.0000000000002622. Erratum in: AIDS. 2020 Nov 15;34(14):2161-2163.Main symptoms<\/h2>\n
HBV<\/h2>\n
Diagnosis<\/h4>\n
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Treatment<\/h4>\n
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Prophylaxis<\/h4>\n
Research<\/h4>\n
HCV<\/h2>\n
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Diagnosis<\/h4>\n
Treatment<\/h4>\n
Prophylaxis<\/h4>\n
Research<\/h4>\n
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Further reading<\/h2>\n
\nhttps:\/\/pubmed.ncbi.nlm.nih.gov\/32694411<\/a><\/p>\n