Hepatitis B
Hepatitis B (often known as HBV) is a type of viral hepatitis that causes inflammation of the liver.
The liver is the largest internal organ in your body. Having a healthy liver is important for everybody, but it is especially important for people with HIV.Your liver has an essential role in processing medicines used to treat HIV and other conditions. Viral infections that affect the liver, such as hepatitis A, hepatitis B and hepatitis C, can make you ill and also mean that the liver is unable to process medicines properly.
When people have both HIV and hepatitis B, this is often described as co-infection. If left untreated, liver disease caused by hepatitis B can be very serious. It is a major cause of illness and death in people co-infected with HIV.
Symptoms
When you first become infected with hepatitis B, you may develop jaundice (yellowing of the eyes and skin), lose your appetite, have pain in the abdomen, nausea or vomiting (feeling or being sick), muscle and joint aches or fever.
These symptoms can be very serious or, in very rare cases, fatal.
Early in the infection, most people will develop protective immunity. However, in about 10% of adults, hepatitis B continues to reproduce in the body long after infection. These people become chronically infected with hepatitis B, meaning that they will be infectious for the rest of their lives, although they may not experience any symptoms.
Some people with chronic hepatitis B eventually develop chronic liver inflammation and have, therefore, increased risk of liver disease (cirrhosis) or cancer of the liver.
HIV-positive people who develop hepatitis B are more likely to become chronically infected with hepatitis B than people without HIV.
Everyone with HIV should have regular tests to monitor the health of their liver. These tests are especially important if you have hepatitis C. If you are co-infected with hepatitis B, doctors will regularly monitor your liver function using blood tests. Ultrasound examinations may also be performed, particularly if your liver shows signs of damage.
How it's passed on
Hepatitis B is passed on by contact with the blood, semen, saliva, or vaginal fluids of an infected person. It is easily passed on during unprotected sex (including oral sex) and from a mother to her baby during delivery. It is many times more infectious than HIV.
Hepatitis B can be avoided by using a condom during vaginal or anal sex, using a condom or dental dam during oral sex and not sharing sex toys.
A vaccine is available to protect you against hepatitis B. This consists of a course of three injections, given over several months. If you are uninfected, and a test shows that you do not have natural immunity against it, you should be vaccinated.
People with HIV can lose their immunity to hepatitis B as their immune system weakens, and should have their level of immunity checked regularly.
Tests and treatment
You should be tested soon after your diagnosis for hepatitis B, to see if you have been infected with the virus. This is done with a blood test.
During the initial period of infection with hepatitis B, it's important to get lots of rest, drink plenty of fluids and avoid paracetamol, alcohol and recreational drugs.
Treatment is available for hepatitis B if your body does not clear the infection itself. If you are HIV-positive and have chronic hepatitis B infection, then you must receive care from a doctor skilled in the treatment of both HIV and hepatitis.
Several drugs are currently available for the treatment of hepatitis B. These are interferon alfa, adefovir (Hepsera) and the anti-HIV drug 3TC (lamivudine, Epivir). Some other anti-HIV drugs are also active against hepatitis B: Tenofovir (Viread) and FTC (emtricitabine, Emtriva).
If you are co-infected with hepatitis B, you should talk to your doctor about how it might affect your anti-HIV treatment options. Having hepatitis B is not thought to make HIV progress faster. Anti-HIV drugs can be used safely and effectively in people with hepatitis B.
Because of the risk of developing drug resistance, you should only take anti-HIV drugs that are effective against hepatitis B as part of an HIV treatment regimen. Nor should you take adefovir unless you are taking HIV treatment because of a risk of resistance. If you are going to take treatment just for hepatitis B (and not for HIV), you should take interferon alfa.
People who have hepatitis B are especially encouraged to start HIV treatment when their CD4 cell count is around 350.
It's also important to understand how your hepatitis treatment may interact with your HIV medication. Find out more about HIV drug interactions.
This article was last reviewed on: 07/09/11
Date due for next review: 07/09/13
