Ask the Doctor: What Is Hepatitis-and-HIV Co-Infection?

Every month, HIV specialist Theresa Mack, M.D., M.P.H. -- an associate medical director at St. Luke's-Roosevelt Hospital's Medical Group in Harlem, N.Y. -- will answer your most pressing HIV/AIDS questions.

Hepatitis is a viral infection that attacks liver cells. There are three main types of hepatitis: A, B and C.

Hepatitis A is a liver infection caused by a virus that does not produce long-term or chronic liver problems. A vaccine can help prevent hepatitis A infection, but if you get hep A, it will usually resolve itself within six months.

Hepatitis B and C can cause cirrhosis, cancer and death. A vaccine to prevent hepatitis B exists, and while hep B cannot be cured, it can be treated. No vaccine exists for hepatitis C; however, the treatment can cure it.

Hepatitis Risk Factors and Symptoms

Go here to read a complete list of hepatitis risk factors, but in the United States they tend to include the following:

• Hepatitis A: contaminated food and water
• Hepatitis B: sexual contact
• Hepatitis C: contact with infected blood, usually by sharing needles and syringes while injecting drugs

While it's often difficult to protect oneself from hepatitis A, hepatitis B and C are more preventable:

• Practice safer sex.
• Don't use injection drugs, or at the very least, never share needles.
• Enroll in a clean-needle exchange program.
• Don't share razors or toothbrushes.
• Patronize only those tattoo and body-piercing facilities that practice sterile techniques and use clean products.
• Get vaccinated against hepatitis A and B.

The three types of hepatitis share some symptoms, which may include general fatigue, nausea, yellow skin, vomiting, light-colored stools and dark urine. But many patients with hepatitis have no symptoms at all. It is especially important to know whether or not you have been exposed to hepatitis B or C.

If you have any of the risk factors -- and particularly if you do and are pregnant -- ask your doctor for a hepatitis C antibody test and hepatitis B antigen and antibody test. There is also a new "rapid test" for hepatitis C that provides results in 20 minutes, similar to the rapid test for HIV.

Hepatitis-and-HIV Co-Infection

Some people contract hepatitis B and C and HIV simultaneously. When one person is infected with two or more viruses, we say that he or she has a co-infection. Common HIV and hepatitis co-infections include HIV and hepatitis C; HIV and hepatitis B; and HIV, hepatitis B and hepatitis C.

In someone who has HIV, hepatitis B and C may cause liver damage and death quicker than they might in someone who does not have HIV. HIV-co-infected patients who begin HAART also risk severe liver damage. In fact, today the medications for HIV are so effective in fighting that virus that liver disease caused by hepatitis B and C has become the most common reason that people living with HIV/AIDS are admitted to the hospital or die.

Treatment and Cure

If you have been exposed to hepatitis B or C or both, your doctor will monitor your hepatitis viral load (the amount of hepatitis virus in your bloodstream). If the hepatitis B or C viral load is low or undetectable, your body has already "cleared" the infection, and treatment is not needed. However, if a liver biopsy shows that a high hepatitis viral load and/or extensive scarring (fibrosis) exists, treatment is warranted to prevent further damage.

Although hepatitis B can't be cured, treatments -- which include some of the same drugs used to treat HIV -- can decrease the amount of virus in the bloodstream and reduce the risk of liver failure. Hepatitis B treatment may consist of a combination of the following medications: adefovir, tenofovir, lamivudine, emtricitabine, entecavir, telbivudine and interferon. With the exception of entecavir, telbivudine and adefovir, these drugs also treat HIV. But while HIV treatment often consists of three-drug combinations, hep B treatments consist of one or two of these drugs. Importantly, an HIV-and-hepatitis B co-infection should be treated simultaneously because HIV drug resistance may occur if the hep B is treated first without also treating the HIV.

Hepatitis C can be cured with treatment, which consists of using two drugs simultaneously: ribavirin and interferon. The treatment-success rate for people without HIV is about 50-60 percent, depending on the hepatitis C strain; the success rate for HIV-co-infected patients is approximately 20-30 percent.

Unfortunately, many patients cannot tolerate the side effects of the medications for either hepatitis B and C or the required lifestyle changes, which include abstaining from alcohol for life.

As told to Tomika Anderson, a freelance writer based in Brooklyn, N.Y.