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Hepatitis B and HIV/AIDS

July 2013

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Diagnosis and Treatment

Many health care providers recommend that people infected with HIV should also be tested for HBV, because people who are infected with both viruses may need to have special treatment with specific drugs (see below) and be checked more often by a health professional.

HBV may cause no symptoms at all. A blood test for the Hepatitis B Surface Antigen (HBsAg) is the only way to be certain if someone is infected. A diagnosis of chronic (long-term) hepatitis B infection is made if the HBsAg test is positive for longer than six months.

Signs and symptoms of HBV may include:

  • Jaundice (yellowing of the skin or eyes)
  • Dark-colored urine
  • Stool that appears pale and clay like
  • Weight loss
  • Extreme fatigue (tiredness) that can last weeks or months
  • Loss of appetite
  • Joint pain
  • Itchy red patches on the skin
  • Nausea
  • Diarrhea
  • Fever and chills

If you have HBV, your health care provider may run other tests such as:

  • HBV viral load: To measure the amount of HBV in the blood
  • Blood tests that check liver function and inflammation
  • Liver biopsy (possibly) to detect liver damage

FibroSure, also known as FibroTest, is blood test approved by the US Food and Drug Administration (FDA) for use in measuring the degree of liver damage. FibroSure is sometimes used instead of a liver biopsy.

There is also a new test called FibroScan™ that takes only ten minutes and may be as useful as liver biopsy in diagnosing HBV. The FDA approved this test in April of 2013. It is non-invasive and painless.

There is no treatment for acute, or initial, hepatitis B. During this short-term infection, health care providers recommend rest, proper food and fluids, and avoidance of alcohol. Many people with chronic HBV who have low HBV viral loads, normal liver enzyme levels, and little liver damage may not need treatment, but they should be checked regularly. For those that do require treatment, the following drugs are currently approved in the US to treat chronic HBV:

  • Pegasys or PEG-Intron (pegylated interferon)
  • Intron A (interferon alpha)
  • Hepsera (adefovir)
  • Baraclude (entecavir)
  • Tyzeka, Sebivo (telbivudine)
  • Viread (tenofovir)
  • Emtriva (emtricitabine)
  • Epivir (lamivudine)
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Emtriva, Epivir, and Viread are drugs that are approved for the treatment of HIV and also have activity against HBV. If you are infected with both HBV and HIV and you are being treated for your HIV with Emtriva, Epivir, or Viread, your HBV infection could get worse if you stop taking the drug.

Studies have shown that therapy with two drugs that are active against HBV may be more effective than therapy with just one anti-HBV drug. The combination of Viread and Epivir was shown to be more effective than Epivir alone for treatment of HBV in patients who were also infected with HIV.

Any of the drugs used to treat HBV infection may cause side effects. Talk to your health care provider about managing side effects and tell him or her if your symptoms get worse. Also talk to your provider if you are pregnant or planning on becoming pregnant, as some of these drugs should be avoided by pregnant women or women who are breastfeeding.

Talk with your health care provider about treatment options and continue to get checked on a regular basis to prevent or minimize liver damage. Besides medical treatment, you can improve the health of your liver by:

  • Avoiding alcohol
  • Eating a healthy diet
  • Getting moderate exercise
  • Reducing stress
  • Being cautious about using drugs, including prescription, over-the-counter, and street drugs. Even drugs containing Tylenol (acetaminophen) should be used under your health care provider's supervision as they may cause liver damage.


HIV Treatment for People Who Are Also Infected With HBV (Co-Infected)

The US Department of Health and Human Services released updated guidelines for the treatment of people co-infected with HIV and HBV in January 2011. These guidelines recommend that all people with HIV/HBV co-infection, including pregnant women, who need HBV treatment or are starting HIV drugs be put on a drug regimen that is active against both HIV and HBV. Currently, Viread plus either Epivir or Emtriva is the preferred treatment for pregnant women infected with both HIV and HBV. While in the US treatment for HIV is recommended for all people living with HIV -- and therefore for anyone co-infected with HIV and HBV -- in many countries HIV drug treatment is based on CD4 cell count.

It is best to talk to your health care provider about treatment options when you are infected with both HIV and HBV. The risk of developing abnormal liver function tests while you are receiving HIV drugs is higher if you are also infected with HBV.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
 
See Also
Talk to a Physician About HIV/Hepatitis Coinfection in Our "Ask the Experts" Forums
More on Hepatitis B

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