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Archival Content: 2012

HIV and Viral Hepatitis

Hepatitis means inflammation of the liver. This condition is most often caused by a virus. In the United States (US), the most common causes of viral hepatitis are hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Hepatitis B and hepatitis C are common among persons who are at risk for, or living with HIV infection.

You can get some forms of viral hepatitis the same way you get HIV. Like HIV, hepatitis B can be transmitted through sexual contact and injection drug use. Hepatitis C is commonly transmitted through injection drug use also. The hepatitis A virus, which causes a short-term but occasionally severe illness, is usually spread when the virus is taken in by mouth from contact with objects, food, or drinks contaminated by the feces (or stool) of an infected person.

Coinfection

Persons with HIV infection are disproportionately affected by viral hepatitis; about one-third of HIV-infected persons are coinfected with either hepatitis B or hepatitis C, which can cause long-term (chronic) illness and death.[1] More people living with HIV have hepatitis C than hepatitis B. Viral hepatitis progresses faster among persons with HIV infection, and persons who are co-infected with both HIV and hepatitis experience greater liver-related health problems than those who do not have HIV infection. Although antiretroviral therapy has extended the life expectancy of persons with HIV infection, liver disease—much of which is related to hepatitis C and hepatitis B infection—has become the leading cause of non-AIDS-related deaths among this population.[2] People living with HIV infection who are co-infected with either hepatitis B or hepatitis C are at increased risk for serious, life-threatening complications. As a result, all persons living with HIV should be tested for hepatitis B and hepatitis C by their doctors. Coinfection with hepatitis may also complicate the management of HIV infection. To prevent coinfection with hepatitis B, the Advisory Committee on Immunization Practices recommends universal hepatitis B vaccination of susceptible patients with HIV infection or AIDS.

The Numbers

  • About 25% of individuals infected with HIV in the US are also infected with HCV, and an estimated 10% of individuals infected with HIV are coinfected with HBV. [1]
  • About 80% of injection drug users (IDUs) with HIV infection also have HCV. [1]
  • HIV coinfection more than triples the risk for liver disease, liver failure, and liver-related death from HCV. [4]
  • About 20% of all new HBV infections and 10% of all new HAV infections in the United States are among MSM. [5] For MSM not infected with HBV or HAV, any sexual activity with an infected person increases their risk. In particular, unprotected anal sex increases the risk for both HBV and HIV among MSM, and direct anal-oral contact increases the risk for HAV.
  • Compared with other age groups, persons aged 46–64 years are 4-5 times more likely to be infected with HCV. [6]
  • Chronic HCV is often "silent," and many persons can have the infection for decades without having symptoms or feeling sick.

Viral Hepatitis Transmission

People can be infected with the three most common types of hepatitis in these ways:

  • Hepatitis A: Ingestion of fecal matter, even in tiny amounts, from close person-to-person contact with an infected person, sexual contact with an infected person, ingestion of the virus from contaminated food , drink, or objects.
  • Hepatitis B: Contact with infectious blood, semen, and other body fluids, sexual contact with an infected person; sharing of contaminated needles, syringes, or other injection drug equipment; and needlesticks or other sharp instrument injuries. In addition, an infected woman can pass the virus to her newborn.
  • Hepatitis C: Contact with blood of an infected person, primarily through sharing contaminated needles, syringes, or other injection drug equipment; and less commonly, through sexual contact with an infected person, birth to an infected mother, and needlesticks or other sharp instrument injuries.

New data suggest that sexual transmission of HCV among MSM with HIV occurs more commonly than previously believed and that sexual transmission can occur undetected among HIV-infected MSM in the absence of injection drug use. [7]

Viral Hepatitis Prevention

Preventing HAV Infection

The best way to prevent infection with hepatitis A is to get vaccinated. Among the groups for whom CDC recommends vaccination against hepatitis A are persons who are at risk for HIV infection, including MSM; users of recreational drugs, whether injected or not; and sexual contacts of infected persons.

Preventing HBV Infection

The best way to prevent infection with hepatitis B is to get vaccinated. Among the groups for whom CDC recommends vaccination against hepatitis B are persons who have or are at risk for HIV infection, including MSM; persons who inject drugs; susceptible sex partners of infected persons; persons with multiple sex partners; anyone with a sexually transmitted infection; and health care and public safety workers exposed to blood on the job.

Preventing HCV Infection

There is no vaccine for hepatitis C. The best way to prevent hepatitis C infection is to never inject drugs, or to stop injecting drugs if you currently do so by getting into and staying in a drug treatment program. If you continue injecting drugs, always use new, sterile syringes and never reuse or share syringes, needles, water, or other drug preparation equipment.

Living with HIV

If you have HIV infection, you can adopt measures to prevent getting hepatitis. These actions will also reduce the chance of transmitting your HIV infection to others. Do not share toothbrushes, razors, or other personal items that may come into contact with an infected person’s blood. Do not get tattoos or body piercings from an unlicensed facility or in an informal setting. These practices may also put you at increased risk for infection with any bloodborne virus if dirty needles or other instruments are used.

Testing and Treatment

Health care providers use blood tests to detect viral hepatitis in their patients. The virus can be detected even if a person has no symptoms. In the case of hepatitis B, the test result can help determine if a person has been infected, and if not, whether he or she would benefit from vaccination. If an antibody test is positive for hepatitis C, a confirmatory test must be done.

Treatment for viral hepatitis varies. More than 99% of persons infected with hepatitis A will recover without treatment. Acute hepatitis B has no treatment; however, both chronic hepatitis B and hepatitis C can be treated with antiviral medications. For hepatitis B, treatment can delay or reserve the effects of liver damage. Many persons infected with hepatitis C experience clearance of the virus as a result of treatment.[8]

Testing for Viral Hepatitis in Persons with HIV Infection

All persons living with HIV should be tested for hepatitis B and hepatitis C by their doctors. Because viral hepatitis infection is frequently serious in persons with HIV infection and may lead to liver damage more quickly, CDC recommends that all persons with HIV infection be tested for hepatitis B and hepatitis C. Coinfection with viral hepatitis may also complicate the treatment and management of HIV infection.

Treating Viral Hepatitis in Persons with HIV Infection

HIV/HBV coinfections and HIV/HCV coinfections can each be effectively treated in many persons. However, managing HIV/HBV and HIV/HCV coinfections is complex, and persons with HIV/HBV or HIV/HCV should seek care from health care providers with expertise in the management of both HIV infection and viral hepatitis.

Coinfected persons should be counseled about drug interactions and side effects of hepatitis and HIV treatments. Deciding if and when to start hepatitis treatment should be individualized, and determining whether treatment is the right choice is a decision each person should make with their health care provider.

Resources

For More Information

Talk to a health professional, call your health department, or visit www.cdc.gov/hepatitis.

Hepatitis Risk Assessment

Take a 5 minute online Hepatitis Risk Assessment to determine your viral hepatitis testing and vaccination recommendations. The tool allows you to answer questions privately, either in your home or a health care setting, and print tailored recommendations based on CDC’s guidelines to discuss with your doctor.

Know More Hepatitis Campaign

Visit www.cdc.gov/KnowMoreHepatitis/ to learn about the campaign.

References:

1. U.S. Department of Health and Human Services. Combating the silent epidemic of viral hepatitis: action plan for the prevention, care and treatment of viral hepatitis; 2011. Available at http://www.hhs.gov/ash/initiatives/hepatitis/actionplan_viralhepatitis2011.pdf. Accessed May 27, 2011.

2. Tuma P, Jarrin I, Del Amo J, et al. Survival of HIV-infected patients with compensated liver cirrhosis. AIDS 2010;24:745–753.

3. Advisory Committee for Immunization Practices (ACIP) Recommendations and Guidelines. Available at http://www.cdc.gov/vaccines/recs/acip/default.htm.

4. Deng LP, Gui XE, Zhang YX, Gao SC, Yang RR. Impact of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. World J Gastroenterol 2009;15(8):996–1003.

5. CDC. Viral hepatitis and men who have sex with men. Available at http://www.cdc.gov/hepatitis/Populations/msm.htm. Accessed May 27, 2011.

6. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006;144(10):705–14.

7. CDC. Sexual transmission of hepatitis C virus among HIV-infected men who have sex with men—New York City, 2005–2010. MMWR 2011;60(28):945–950.

8. FDA. News release: FDA approves Incivek for hepatitis C; May 23, 2011. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm256299.htm. Accessed May 27, 2011.



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