Guide to Hepatitis B for People Living With HIV

Section 11: Other Viral Hepatitis

Hepatitis A (HAV)

HAV is found in feces (stool). People become infected when feces from a person who is infected with HAV enters their mouth. This may occur when food (including raw or undercooked shellfish) or water is contaminated with sewage; when an infected person handles food without washing his/her hands after using the bathroom; through oral-anal sex with an infected person (also known as rimming); and, rarely, from blood transfusions.

A vaccine is available to prevent HAV infection, and every person with HIV or HBV should be vaccinated (though it may be less effective in people with low CD4 cell counts.)

Some people with HAV -- especially children -- don't feel sick at all; others have symptoms including nausea, vomiting, diarrhea, fever, fatigue, rash, jaundice, liver pain, and dark brown urine. There is no treatment for HAV itself, but the symptoms can be treated.

HAV is not a chronic infection -- it goes away by itself, usually within two months. A person can be infected with HAV only once.

Hepatitis C (HCV)

HCV is found in blood (very small amounts have been found in semen and vaginal fluid). You can get HCV from:

• Sharing drug-use or tattoo equipment, including needles; measuring syringes; water; cookers; cotton; and tattoo ink and inkwells;
• Unprotected sex (especially if you have a sexually transmitted infection such as herpes, syphilis, or HIV) that involves blood: rough anal or vaginal sex, and fisting, are riskier;
• Mother to child during birth; and
• Sharing personal-care items that may have blood on them, such as razors and toothbrushes.

You can get HCV more than once, even if you already cleared it with treatment or through your own immune response.

Most people have no symptoms when they are first infected; about 20% will experience nausea, abdominal pain, appetite loss, fatigue, jaundice (yellow skin and eyes), and dark urine. HCV infection can become chronic (lifelong) in 55-85% of people; the rest clear the virus without treatment.

About 20-30% of chronically infected people will develop cirrhosis over the decades. Each year, 1-5% of people with cirrhosis develop liver cancer.

HCV can be treated -- and cured -- with a combination of pegylated interferon and ribavirin, but HCV treatment does not always get rid of the virus, and the side effects can be severe. New therapies are currently in development.

Recent outbreaks of sexually transmitted HCV have been reported in HIV-positive gay men in the U.S., some European cities, and Australia. A cluster of risk factors has been identified, including non-injection drug use; group sex; rough, long-lasting anal sex; fisting; and being HIV-positive.

All HIV-positive people should be screened for HCV. HIV makes HCV worse: it is more likely to be chronic, progresses more quickly, and is harder to treat. Hepatitis C is worse in people who are coinfected with hepatitis B.

There is less research on HIV coinfection with these viral hepatitis infections:

Hepatitis D (HDV) -- a virus that infects only people with hepatitis B. HDV increases the risk of cirrhosis and the rate of liver disease progression for people with HBV. HIV coinfection may also accelerate HDV-related disease progression. A vaccine protecting against HBV also protects against HDV infection. Treatment options are very limited; research into this area is ongoing.

Hepatitis E (HEV) -- an infectious virus with characteristics similar to hepatitis A. HEV will clear without treatment over several weeks to months. There is no vaccine for HEV. You can be infected with this virus only once. People with underlying liver disease may be more susceptible to serious liver damage and liver failure.