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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
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HIV positive, worried about HCV and HBV!
Nov 18, 2007

Hello Doctor

Please can you help me, i'm increasing worried about a couple of things. I am HIV positive and doing extremley well on medication, undectable viral load and CD4 of 500. The thing is i am worried about catching HBV or HCV on top of the HIV, as I've heard and read may things that if you have both that your life expectancy is very minimal and that both viruses together are very hard to treat,is this true? I must stress that I am with a long term partner who we are both committed to each other and always NOW use protection when we have sex together and neither of us are drug IV users, my problem is that i've read that you can and that it is a high risk factor of catching HBV and HCV through someone using your razor/toothbrush, I live in a shared house and i'm scared that someone might of used my things, or vice versa for there saftey too. is this correct? I was given a course of HCV/HBV vaccination's last year and it was repeated again this year due to it not responding very well in my system, i have discussed this with my health adviser and she assures me that i have nothing to worry about evan if someone has used my things and that i do not warrant another Hep test. What do you think? Also, i was tested in May this year for HCV/HBV and both came back negative. Please could you advise? Also if someone with HIV also had a hep infection, what would there life expectancy be? As I here alot about HIV people doing well and Hep people doing well - but what about if you have both?

I no there is alot to answer here, thank you for taking you time in reading this - you all do such a wonderful thing on this site - THANK YOU!

Annie from the UK

Response from Dr. McGovern

You ask some good questions:

1. Yes you should avoid sharing razors. This is part of guidelines, but I think in reality the risk is low. I would still try to use your own razors - and to decrease your anxiety, I would simply get a plastic box for your shower stuff for you to take in and out of the shower. This way you will be more reassured about your own belongings.

2. If you just got tested in May, I would hold on retesting for now. Once yearly may be reasonable if your partner is positive. Continue the good work on the condom use. Hepatitis B is much more readily transmissible through sex than hepatitis C.

3. You may want to discuss getting a "double dose" of hepatitis B vaccine. Recommendations will be coming out in the new USPHS guidelines in a few months. Perhaps you can have your provider look into that even though you are from the UK.

3. I think patients with HIV and hepatitis B need to have the best HIV "cocktail" that includes drugs with HBV activity as well. I think HIV/HCV patients need careful evaluation of their liver disease and appropriate treatment. If the treatment does not work, there are new drugs in development that I am hopeful will change response rates in HIV infected patients dramatically in the years to come.

The main problem as I see it is that some patients do not have evaluation for HCV just because their liver function tests are normal or slightly abnormal. I don't agree with this approach. Anyone with HCV VIREMIA (eg, virus in their blood) should be evaluated for liver disease. You can't tell how much HCV-related liver disease someone has by looking at their ALT.

Hepatit B infeksjon
further manegment for hep b

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