HIV and Hepatitis

I know that recently a great deal has been written about hepatitis. As a matter of fact, the Gay and Lesbian Medical Association has endorsed universal vaccinations for MSMs (men who have sex with men) against hepatitis A and B as well as injection drug users. Because HIV and hepatitis are both transmitted by the same means, we are finding that a number of people with HIV are also living with hepatitis. In this article, I want to cover the basics for our first time readers, as well as cover some information that is not so widely known.

At this time, hepatitis C is an epidemic. In response to this, many organizations have initiated educational campaigns to get the word out about this virus. Remember, Knowledge = Power, and at this time information is our most powerful tool in our fight against hepatitis. Read! Get tested! Get vaccinated!

The Facts

(Information provided by American Liver Foundation -- Georgia Chapter, HIV Frontline, Schering Corporation, The Body and Positively Aware.)

  • Viral hepatitis is a disease that is characterized by the inflammation of the liver.

  • An estimated 400,000 to 500,000 Georgians currently have some form of hepatitis.

  • More than five million people have some form of viral hepatitis in the United States.

  • So far, there are six known kinds of viral hepatitis: A, B, C, D, E and G.

  • The three most common types are A, B and C.

  • Hepatitis B and C can lead to serious, permanent liver damage, sometimes resulting in death.

  • People with chronic hepatitis should not take large doses of vitamin A, which can be toxic to the liver.

  • Vitamin E appears to have beneficial effects on the liver.

  • People with hepatitis C should avoid chemical fumes and other environmental toxins such as solvents and pesticides as much as possible.

  • Many nutritionists recommend a diet rich in whole grains, fruits and vegetables, with a minimum of chemical additives. People with liver-related encephalopathy may want to limit their protein consumption to avoid the creation of byproducts that can be toxic to the brain.

  • Foods with high salt, sugar or fat content, such as cheese, pickles, fast food and processed foods, stress your liver.

  • Please consult with your HIV doctor before starting on any hepatitis treatment to make sure that your hepatitis and HIV medications are able to work together.

  • On January 5, JAMA (the Journal of the American Medical Association) published a study by John Hopkins researchers, who reviewed charts of 298 patients who were beginning antiretroviral treatment. The major findings were: 1) that persons with chronic viral hepatitis (usually hep C, in this study) can be treated safely with protease inhibitors, and 2) that ritonavir was much more likely to cause liver problems than the other protease inhibitors (a result that differs from that of some other studies, for reasons that are not known).

Hepatitis A

  • It infects 150,000 Americans annually.

  • It is transmitted through food or water contaminated by human waste.

  • Most people recover within six months.

  • A vaccine is available.

  • Some people with hepatitis A may not have symptoms, especially children under 2 years old. In most cases, however, people experience "flu-like" symptoms, including fatigue, nausea with vomiting, and pain in the liver area. Less common symptoms are dark urine, light-colored stools and fever.

  • Most hepatitis A infections are acute and do not typically need medical treatment. Avoiding alcohol is the common recommendation.

  • The way hep A works in the body is not well understood. Virtually all people get better on their own. You can only get it once.

Hepatitis B

  • Approximately 1.2 million Americans currently have hepatitis B (HBV).

  • It is transmitted by infected blood and body fluids including semen, vaginal secretions and saliva.

  • Sexual contact is the most common means of transmission.

  • Some people with HBV have no outward signs or symptoms. But others do experience "flu-like" symptoms such as fatigue, loss of appetite, nausea with vomiting, fever, weakness and mild abdominal pain. Less common symptoms are dark urine and yellowing of the skin and eyes (jaundice).

  • Treatment that is typically recommended is a manufactured form of interferon.

  • HBV infects liver cells, causing swelling and the tissue to die. Your own immune system response causes some of the symptoms associated with HBV infection.

  • The change in immune status during HAART in persons with HIV infection may be associated with the reactivation of latent hepatitis B virus infection in patients with markers of past HBV exposure according to findings presented at the Third International Conference on Therapies for Viral Hepatitis.

  • 3TC and interferon-alpha (Intron-A) in combination was shown by Francesca Jaboli, MD to be more effective than Intron-A alone.

  • A vaccine is available.

Hepatitis C

  • An estimated four to five million Americans currently have chronic hepatitis C (HCV).

  • Transmitted through blood and blood contact.

  • Most people with hepatitis C have no outward signs or symptoms. But others do experience "flu-like" symptoms, such as fatigue, loss of appetite, nausea with vomiting, fever, weakness and mild abdominal pain. Less common symptoms are dark urine and yellowing of the skin and eyes (jaundice).

  • HCV infects your liver, causing swelling and the death of cells and tissue. HCV works similarly to HBV, but not much is understood about how HCV causes harm.

  • It is estimated that 36,000 people will die annually from HCV within the next 10 years.

  • 75% of people with HCV have no symptoms.

  • Liver failure due to HCV is the leading cause of liver transplants in the United States.

  • HCV is the most common blood-borne infection in the USA.

  • The overall prevalence of HCV infection across population of HIV-infected patients ranges from 3% to 44% (but can be as high as 70% to 85% in IDUs and hemophiliacs), depending mainly on demographics.

  • Six main strains (or genotypes) of HCV have been identified worldwide.

  • In the United States, 70% to 80% of patients are infected with genotype 1, which is apparently associated with a high HCV viral load in patients coinfected with HIV.

  • Genotype 1 tends to be less responsive to treatment than do genotypes 2 and 3.

  • Most studies suggest that HCV does not contribute to a faster progression of HIV disease, while HIV does accelerate HCV disease progression although there is some debate.

  • Interferon-alpha (Intron-A) and ribavirin (Rebetol) are used in combination as a treatment often referred to as Rebetron. A year's supply of Rebetron costs about $18,000 per year. These drugs are sold together in a kit. Some treatment advocates object to the fact that a single bundled combination of interferon/ribavirin was approved. Bundling means that people with hepatitis C cannot use ribavirin in combination with other brands of interferon that might work better or cause fewer side effects in some individuals. It also means that people must purchase the drugs in the doses sold in the Rebetron kit, which prevents people from using smaller or larger amounts of either drug without incurring the expense of wasted medication.

  • Rebetron was originally approved for the treatment of pediatric respiratory syncytial virus.

  • Fisher's Specialty Pharmacy Services has decided to sell its own version of ribavirin, which persons with HCV can combine with whatever brand of interferon they choose. Fisher's ribavirin is 80% less expensive than Schering-Plough's Rebetron. (Fisher's Specialty Pharmacy Services 1-888-347-3416).

  • Women should test negative for pregnancy at the beginning of treatment and must practice two types of effective birth control during the treatment and for six months after treatment. Treatment may cause miscarriages or birth defects.

  • Alternative and complementary therapies have been used to treat people with chronic liver disease. The following are some herbs that have been used: milk thistle, licorice root, dandelion, astragalus, bupleurum, garlic, artichoke, thioctic, black walnut, zhi zi, da huang, long dan cho, long dan xie gan tang, yin chen hao tang and sho saiko to. Herbs such as chaparral, comfrey, pennyroyal, germander, mistletoe and skullcap have proven toxic to the liver.

  • There is no vaccine.

Common Questions about Hepatitis

(Information taken from e-mail questions to Dr. Dieterich with The Body.

Q: What causes hepatitis?

A: Hepatitis is a term for inflammation of the liver. It can be caused by drugs, alcohol or viruses.

Q: Could you please let me know what diseases can be caused by HCV? Is arthritic joints one of them?

A: Yes. Many people with HCV have joint pains. The three classic illnesses caused by it are cryoglobulinemia, which causes antibodies to clog up in the cold, porphyrea cutanea tarda, which causes skin rashes and a constellation of other problems. Arthritis (the third) is a very common disease, so make sure you get your hepatitis treated.

Q: How does hepatitis C affect AIDS?

A: There are several studies, one from Italy and one from the Atlanta VA, that suggest that HCV has no effect on HIV. However, it does appear that some studies show the opposite effect (i.e., that HCV does increase perinatal transmission and decreases T-cells). A study from England has shown that genotype 1 HCV patients die from AIDS much faster than all other genotypes. There is not a clear answer to this question. Both diseases should be treated by experienced health care providers.

Q: How long will the liver stay healthy in a person who has both hepatitis C and AIDS?

A: In an individual case, there is really no guessing without a biopsy. However, the population statistics indicate that the median or average time to cirrhosis in people who do not have HIV is about 20 years and it is about 10 years in people who have HIV. The course of disease is about twice as fast in the HIV-infected community.

Q: What is the possible danger of antiretroviral therapy with a gallon-a-week drinker who has HBV and HIV?

A: The danger is not from the antiretroviral therapy, but from the alcohol. It will accelerate the course to cirrhosis and end-stage liver disease. The alcohol needs to stop ASAP.

Q: Is it possible for HCV to be dormant and not show up on previous blood tests and then all of a sudden have a raised liver enzyme? I had a normal blood test about a year before the raised liver enzyme test. I had no transfusions or intravenous use of needles, but my spouse was having an affair in that interim period. Is it possible it was sexually transmitted to me since I did not have these enzymes prior?

A: It is possible to transmit hepatitis C sexually, but it is rare. The enzymes are a very unreliable test and both of you should have a quantitative PCR test of the virus to be certain of the diagnosis . If you have it, you should be seen by an experienced clinician of hepatitis and evaluated for therapy!

Q: Do the hepatitis vaccines work on all three strains?

A: There are very effective vaccines for both hepatitis A and hepatitis B. In fact there may be one shot that combines both vaccines coming out soon. There is unfortunately no vaccine for hepatitis C.

Q: How are the three strains of hepatitis contracted by people?

A: Hepatitis A is transmitted by mouth. It has to be swallowed, so that it is usually transmitted by food, although oral/anal sex is another way to get it. Hepatitis B is transmitted through sex and blood, but most commonly sex. Hepatitis C is usually spread by blood, the most common way is through shared needles used for drug use. The risk of sexual transmission of hepatitis C is low except if people have sexually transmitted diseases as well or HIV.

Risk Factors

Finally, if you answer "yes" to any of these questions you could be at risk for hepatitis, and should consider going to get tested for hepatitis:

  • Have you had a blood transfusion prior to 1992?

  • Have you ever used intravenous or intranasal drugs?

  • Are you a health care professional or do you work in another occupation with exposure to blood or blood products?

  • Have you had unprotected sex with someone who has hepatitis B?

  • Do you have a tattoo or body piercing?


In Georgia:

American Liver Foundation
Hepatitis and Liver Disease Support Group
2nd Thursday of Each Month
7:00 to 8:30 p.m.
HEP 101 workshop

AID Atlanta (in Georgia)
Information on Hepatitis A, B, C; Community presentations; Written materials; Referrals for vaccines.


National Liver Foundation Hotline

HepB Foundation
Doylestown, PA

Latino Organization for Liver Awareness
Provides counseling for people with liver disease.
English and Spanish

Hepatitis Education Project

The Hepatitis Usenet Group

Hep C Connection
Call for referrals to support groups in your area, if one exists.

The Hepatitis C Foundation

The Body
An AIDS and HIV Information Resource Hepatitis section at The Body

HIV and

Hepatitis Newsletter
McMillen Communications

Hepatitis Foundation International
Newsletter, find a support group near you, physician referral.

Hepatitis C Action and Advocacy Coalition
haac_sf@ .com