Hepatitis and HIV Co-Infection

Posted by e-Medical PPT Wednesday, October 24, 2012
Viral Hepatitis in HIV+ Patients
Acute viral hepatitis may be severe or fatal
Acute viral hepatitis may add to liver damage already present from other causes
e.g. Acute hepatitis A on other chronic viral hepatitides may be deadly

Hepatitis A & HIV, in Brief
Role seems significant
35 HIV+ with acute HAV
80% treatment interrupted X ~ 2 months
25% lost efficacy on resuming HAART
safe, effective VACCINE available for Hepatitis A and B – vaccinate!

Hepatitis C
Transmitted via IVDU/contaminated blood/perinatal > sex (receptive AS & STD)
In U.S., 4 million HCV+ → 85% chronic
If chronic → 20% cirrhotic @ 20 - 40 years
Once cirrhotic → 25% hepatocellular CA
    (0.5% of total HCV+)
Alcohol & HIV worsen prognosis
Usually no symptoms but sometimes fatigue, RUQ ache, difficulty concentrating or isolated  ALT/AST

Compared to HCV mono-infection, co-infected patients have:
More rapid progression to
decompensated liver disease

Diagnosing HCV in HIV
Do not rely on transaminases! There is no correlation between transaminase levels and disease severity.
HCV ELISA antibody screening
+ Antibody means “infected at some point”, need to determine if active or chronic infection
In advanced HIV, may be falsely negative
HCV RNA PCR confirms or excludes active disease
+ Viral load means “active hepatitis”
Quantitative HCV VL does not correlate with degree of liver damage and is not a surrogate marker for disease progression

Chronic Hepatitis C
Consider opioid substitution therapy if active drug abuse
Assure immunity to Hepatitis A & B;  in not immune, offer vaccines
Obtain Genotype
Counsel on condoms and safer sex
Introduce risks vs. benefits of treatment
Assess if benefit of treatment outweighs risk

Hepatitis C Screening
Genotyping & Hep C VL are helpful in predicting response to therapy
1 ( & 4) is more refractory to treatment
If VL < 800,000 IU/mL, Geno 1 easier to treat
2 & 3 are very responsive
Attempt to get CD4>200 with ART
Pts with CD4% > 25% are more likely to have SVR
Preg. test unless hysterectomy or tubal ligation
CBC, Platelet, CMP/Lipid, PT with INR, PTT
TSH (autoimmune thyroiditis potential complication of therapy)
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