National Emergency Response Council on HIV/AIDS

PEOPLE WITH HIV WHO HAVE UNDERLYING LIVER DISEASE ARE AT RISK FOR SEVERE DISEASE FROM HEPATITIS INFECTION.

17 August 2021

 

People with HIV who have underlying liver disease are at risk for severe disease from Hepatitis infection.

……..should be vaccinated against hepatitis A and B and tested for hepatitis B and hepatitis C

 

MBABANE- Yesterday the world came together in celebration of World Hepatitis Day. World Hepatitis Day is observed each year on 28 July to raise awareness of viral hepatitis, an inflammation of the liver that causes severe liver disease and hepatocellular cancer. Hepatitis means inflammation of the liver.

The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus. The date of 28 July was chosen because it is the birthday of Nobel-prize winning scientist Dr Baruch Blumberg, who discovered Hepatitis B virus (HBV) and developed a diagnostic test and vaccine for the virus. This year’s theme is “Hepatitis Can’t Wait”. With a person dying every 30 seconds from a hepatitis related illness – even in the current COVID-19 crisis – we can’t wait to act on viral hepatitis. There are five main strains of the hepatitis virus – A,B, C, D and E. Together, hepatitis B and C are the most common which result in 1.1 million deaths and 3 million new infections per year. Hepatitis A is a viral liver disease that can cause mild to severe illness.

Symptoms:

Many people with hepatitis do not have symptoms and do not know they are infected. If symptoms occur with an acute infection, they can appear anytime from 2 weeks to 6 months after exposure. Symptoms of chronic viral hepatitis can take decades to develop. Symptoms of hepatitis can include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured stools, joint pain, and jaundice.

The Hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person. Almost everyone recovers fully from Hepatitis A with a lifelong immunity. However, a very small proportion of people infected with Hepatitis A could die from fulminant hepatitis (acute liver failure). Handwashing plays an important role in prevention. Practicing good hand hygiene— including thoroughly washing hands with soap and warm water after using the bathroom, changing diapers, and before preparing or eating food—plays an important role in preventing the spread of many illnesses, including Hepatitis A. Safe water supply, food safety, improved sanitation, and the Hepatitis A vaccine are the most effective ways to combat the disease. Persons at high risk, such as travellers to countries with high levels of infection, can get vaccinated before they travel.

Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic

disease. The virus (HBV) is most commonly transmitted from mother to child during birth

and delivery, as well as through contact with blood or other body fluids, including sex with

an infected partner, injection-drug use that involves sharing needles, syringes, or drug-

preparation equipment and needle sticks or exposures to sharp instruments.

It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer. A safe and effective vaccine that offers a 98-100% protection against hepatitis B is available. Preventing Hepatitis B infection averts the development of complications including the development of chronic disease and liver cancer. Vaccination is the best way to prevent Hepatitis B. The Hepatitis B vaccine is typically given as a series of 3 shots over a period of 6 months. The entire series is needed for long-term protection. Hepatitis B vaccination is recommended for:

•All infants are routinely vaccinated for Hepatitis B at birth,

•people living with someone infected with Hepatitis B,

•Healthcare and public safety workers exposed to blood.

•People with high-risk sexual behaviours, people who inject

drugs, and

•people who have certain medical conditions, including diabetes, should talk to their healthcare providers.

People with HIV and Hepatitis A

People with HIV who have underlying liver disease are at risk for severe disease from hepatitis A infection, and widespread hepatitis A outbreaks associated with person-to-person transmission have been occurring since 2016. Therefore, the Centre for Disease Control (CDC) recommend hepatitis A vaccination for this population. Because the response to the vaccine might be reduced in people with HIV infection who are immunosuppressed, postvaccination serologic testing should be performed for all people with HIV infection 1 month after completing the hepatitis A vaccine series. All people with HIV infection who receive hepatitis A vaccine, regardless of postvaccination serologic testing results, should be counselled that the vaccine might not provide long-term protection against hepatitis A. Therefore, they might need to receive immune globulin (IG) after a high-risk exposure (e.g., a sexual or household contact).

People with HIV and Hepatitis B

Hepatitis B virus (HBV) and HIV are bloodborne viruses transmitted primarily through sexual contact and injection-drug use. Because of these shared modes of transmission, a high proportion of adults at risk for HIV infection are also at risk for HBV infection. People with HIV who become infected with HBV are at increased risk for liver-related morbidity and mortality . To prevent HBV infection in people with HIV, CDC recommends universal hepatitis B vaccination for all susceptible people infected with HIV. The first vaccine dose can be administered immediately after collection of blood for prevaccination serologic testing and regardless of CD4+ lymphocyte cell count .

To confirm adequate immune response, post-vaccination serologic testing for protective concentrations of antibodies to hepatitis B surface antigen should be conducted 1–2 months after completion of the hepatitis B vaccine series . People with HIV who test positive for HBV should receive HIV antiviral medication with activity against HBV (e.g., tenofovir and entecavir).

People at increased risk for Hepatitis

 

  • International travellers
  • Men who have sex with men
  • People who use or inject drugs (all those who use illegal drugs)
  • People with occupational risk for exposure
  • People who anticipate close personal contact with an international adoptee
  • People experiencing homelessness
  • People at increased risk for severe disease from hepatitis A infection
  • People with chronic liver disease, including hepatitis B and hepatitis C
  • People with HIV

 

 

 

 

KEY FACTS

Hepatitis A

Hepatitis B

  • Effective vaccine available
  • Outbreaks still occur; currently there are widespread person-to-person outbreaks
  • Recent foodborne outbreaks traced to imported food
  • Common in many countries, especially those without modern sanitation
  • Effective vaccine available
  • About 2 in 3 people with hepatitis B do not know they are infected
  • Hepatitis B is a leading cause of liver cancer