Hepatitis B and C

Hepatitis B is caused by a virus in blood and body fluids. Hepatitis B causes inflammation of the liver and can cause liver fibrosis (scarring), cirrhosis, and liver cancer. Hepatitis B is more infectious than HIV.

Symptoms Hepatitis B symptoms may include a mild flu-like illness, loss of appetite, abdominal pain and discomfort, vomiting and nausea, pale faeces, aching joints and jaundice (recognised by yellowing of the eyes). People with Hep B virus can suffer recurring symptoms, including serious liver damage. A blood test is used to determine a diagnosis. This may show up as ‘positive’ between one and six months after exposure to the virus. The majority of adults, 95%, will clear the virus from their body after infection. A small number will become chronic carriers of hepatitis B.

Transmission Hepatitis B can be passed on through infected blood or body fluids through sex (including oral sex) or by sharing injecting equipment, toothbrushes or razors, and tattooing and body piercing with un-sterile equipment. Hepatitis B can be passed on to a baby during pregnancy or childbirth. Like HIV, hepatitis B is present in breast milk and can be passed on to a baby when breastfeeding.

Hepatitis B and HIV Hepatitis affects the liver, so your ability to tolerate some HIV treatments (which are metabolised through the liver) may be reduced. Studies have failed to find a link between hepatitis B and more rapid HIV disease progression, although some have suggested a link may exist.

Treatment People who have HIV and hepatitis B are usually advised to commence treatment for hepatitis B. In practice, two commonly used HIV antiretroviral drugs also treat hepatitis B infection. Your doctor would usually include these drugs in your HIV treatment combination when you start HIV treatment, thus treating both viruses at the same time. Sometimes when HIV treatments are first commenced they can cause a “flare” of inflammation of the liver. Your doctor will monitor this situation.

Treatment does not cure hepatitis B but it can change an aggressive infection into a mild one, helping stop damage to the liver.

Prevention Male or female condoms should be worn during anal or vaginal sex or other genital contact. Clean injecting equipment must be used when injecting drugs. Sharing razors or toothbrushes is not recommended. The only guaranteed preventative measure if you do not have hepatitis B, is vaccination, which can be safely used if you’re HIV positive. A good response to vaccination is more likely if your immune system is strong. All sexual partners of people with hepatitis B and all household members should also be vaccinated if they do not already have immunity.

For more information see Hepatitis Australia’s pages on Hepatitis B.

Hepatitis C (Hep C) is a viral infection that affects the liver. The Hep C virus lives in the blood and liver cells where it can cause inflammation and scarring (called fibrosis) or cirrhosis, which is more serious. Hep C can potentially cause long-term, serious health problems, including liver failure and cancer. However, recent treatment advances mean more and more people will now be cured of their Hep C infection.

Some women with HIV in Australia have both HIV and Hep C. When people have both HIV and hepatitis C, they are described as having a co-infection.

The emotional and physical effect of an HIV and Hep C diagnosis should not be underestimated. It can be particularly stressful because there are not always clear-cut answers about how to manage both conditions together. It is important to allow yourself the psychological and emotional space to deal with these issues and to get expert advice. There are numerous support groups and organisations for people with Hep C, including Hepatitis Australia. Your doctor can also provide advice and refer you for more information about treatments or counselling.

Symptoms Hepatitis C infection does not mean the same thing for everybody. Research suggests that approximately 25% of people who are infected with Hep C clear the virus completely within two to six months of infection although they continue to have Hep C antibodies in their blood. The other 75% of people are at risk of developing ongoing (or chronic) infection and cirrhosis of the liver. Of those people who develop chronic hepatitis, about 20% will not experience any noticeable illness or symptoms, however, they can still transmit the virus to others.

After a period of 15 years, most people with chronic Hep C infection will experience some symptoms and develop some liver damage. After 20 years, some will develop cirrhosis. A small number will experience liver failure or develop a form of liver cancer known as hepatocellular carcinoma.

Transmission Hep C is much more infectious than HIV. It is usually transmitted via blood exposure. Research suggests that Hep C is also sexually transmissible, although this occurs much less frequently than with HIV or hepatitis B. The hepatitis C virus can be found in menstrual blood, suggesting the importance of safe sex (using condoms). Hepatitis Australia’s Need-To-Know News on Hepatitis C Treatment details the latest information.

Hep C and HIV There is evidence that HIV may cause a more rapid progression to liver damage in people with Hep C. This is because HIV appears to increase Hep C viral load. It is less clear what effect Hep C has on HIV infection. Studies have produced conflicting results, including some that indicate having Hep C does not necessarily increase the impact or disease progression associated with HIV.

One area where Hep C can have a serious impact, however, is in the area of HIV treatments. There are a number of anti-HIV drugs which are toxic to the liver, and these are used with care in people who have abnormal liver function or evidence of inflammation. It is important you see an HIV doctor experienced in treating HIV and Hep C co-infection. Regular liver function tests and other tests including scans relating to the liver are particularly important if you also have Hep C.

Treatment Hepatitis C treatments are currently developing at a rapid pace. Recent research suggests that soon most people with Hep C will be able to be cured by much shorter term treatment than ever before. For up-to-date information check out Hepatitis Australia’s Hep C treatment page and talk to your doctor.

Note: Use of the current Hep C drugs Ribavirin or Rebetron are definitely not recommended if you are pregnant or are considering pregnancy. For more specific information relating to Women and Hepatitis visit Hepatitis Australia.

Alternative therapies may be a useful way of assisting your body, particularly your liver, to cope with both the physical and psychological impacts of HIV and Hep C. It is also useful to pay attention to your diet, reduce alcohol consumption, avoiding binge-drinking and do some exercise.

Herbal formulations may be beneficial but be aware, some can actually cause damage. While it is often thought that herbs are ‘safe’ and ‘natural’, there are documented cases of some herbal medications causing liver damage. As with alternative therapies for HIV, make sure you find a qualified, reliable practitioner for any alternative therapy you may wish to use. See Hepatitis Australia’s Complementary Therapies page or contact your local Hepatitis support organisation for more useful tips.

Prevention Hepatitis C is primarily transmitted through blood to blood contact. The highest risk activity is the sharing of needles, syringes, or other drug injecting equipment like tourniquets. Hep C can also be transmitted through tattooing equipment or body piercing equipment which is not sterile. Some people have been infected with Hep C through blood transfusions but all blood is now screened before transfusion. People with hepatitis C should not share tooth brushes or razors.