Co-Infection

What is Hepatitis Hepatitis is inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar, the root being hepat, meaning liver, and suffix -itis, meaning inflammation. Liver acts as a chemical power plant Produces clotting factors Produces proteins Filters toxins Stores vitamins & nutrients Regulates hormones Symptoms of Hepatitis Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide, but it can also be due to toxins, other infections and autoimmune diseases. Jaundice, which causes a yellowing of the skin and eyes Fatigue Abdominal pain Loss of appetite Nausea Vomiting Diarrhea Low grade fever Headache However, some people do not have symptoms. Hepatitis A, B, C, D and E Hepatitis A (HAV): Jaundice, self-limiting, never becomes chronic. Hepatitis B (HBV): Becomes chronic in only 10% of the cases. Hepatitis C (HCV): Becomes chronic in 85% of people exposed to it. Hepatitis D (HDV): Affects only if already infected with hepatitis B. Hepatitis E (HEV): Spreads by drinking water infected with the virus. It can also spread through oral-anal contact. Hepatitis A Virus HAV is caused by eating food and drinking water infected with a virus called HAV. It can also be caused by anal-oral contact during sex. While it can cause swelling and inflammation in the liver, it doesn’t lead to chronic, or lifelong, disease. Almost everyone who gets hepatitis A has a full recovery. Formerly prevented with gamma globulin New effective vaccine Hepatitis B Virus HBV can spread by: Sharing drug needles. Getting tattoo or body piercing with dirty tools. Getting pricked with a infected needle. Sharing a toothbrush, razor, or other personal items. An infected woman can give HBV to her baby at birth or through her breast milk. Through a bite from another person. HBV becomes serious infection that causes liver damage, resulting in cancer. Enveloped DNA virus Recombinant vaccine Hepatitis C Virus HCV spreads the same way as HBV, through contact with an infected person’s blood, semen, or body fluid. It causes swelling of the liver and causes liver damage that can lead to cancer. This may lead to a scarring of the liver, called cirrhosis. More likely than HBV to become chronic. No vaccine Hepatitis D Virus HDV is caused only if you are already infected with HBV. It is spread through contact with infected blood, dirty needles that have HDV on them, and unprotected sex with a person infected with HDV. It causes swelling of the liver. Hepatitis E Virus HEV is caused by drinking water infected with the virus. It causes swelling of the liver, but no long-term damage. It can also be spread through oral-anal contact. How Hepatitis is Spread? Hepatitis C Treated with Interferon alpha and ribavirin No cure but slows liver damage Transmission Hepatitis C: End-Stage Accumulation of serous fluid in peritoneal cavity Jaundice Bleeding – varices Mental confusion Weight loss Severe itching Swelling from excessive accumulation of watery fluid in cells Possible Related Problems These conditions do not indicate HCV infection but testing should be considered if no other cause can be identified. Kidney Damage Cryoglobulinemia Autoimmune Disorders Skin Conditions Thyroid Disease Type-II Diabetes Liver Cancer HCV/HIV Co-Infection When a person has HIV and hepatitis C, it’s referred to as co-infection and should be tested for hepatitis A, B and C. If negative for A and B, they should talk to their doctor about getting vaccines for A & B. Find a doctor knowledgeable about both HIV and HCV, and start discussing treatment Strategies for HIV and HCV. Discussions about treatment strategies should include consideration of the benefits and risks of immediate or deferred HCV treatment. Decisions to treat should be made on an individual basis. Treatment The decision to treat is a complex issue which must be made in consultation with a qualified physician, taking into consideration the following variables: Age of the patient General state of health Risk of cirrhosis Likelihood of response Other medical conditions that may decrease life expectancy or contraindicate the use of interferon or ribavirin. Patients with moderate/severe necro-inflammation and/or fibrosis should be treated. Treatment Options Currently there are only two options for Allopathic method of treatment of HCV infection. Interferon / Ribavirin (combination) Pegylated Interferon / Ribavirin (combination) All treatment decisions should be made by the patient and their treating physician. Treatment HAV HAV vaccine is available. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling and practicing good hygiene and sanitation also helps prevent hepatitis A. It usually resolves on its own over several weeks. Treatment HBV The HBV vaccine is available for the best protection. Drugs approved for the treatment of chronic HBV include Alpha Interferon and Peginterferon, which slows the replication of the virus in the body and also boost the immune system. The antiviral drugs Lamivudine, Adefovir Dipivoxil, Entecavir, and Telbivudine. Severe acute HBV can be treated with an antiviral drug such as Lamivudine. Treatment HCV There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Chronic HCV is treated with Peginterferon together with the antiviral drug Ribavirin. If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended. Treatment HDV People not already infected with hepatitis B should receive the HBV vaccine. Chronic HDV is usually treated with Pegylated Interferon. Treatment HEV There is no approved vaccine for HEV. The only way to prevent the disease is to reduce the risk of exposure to the virus. Hepatitis E usually resolves on its own over several weeks or months. Alternative Treatment