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
cirrhosis
decompensated liver disease
HCC
death

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
STOP ALL ETHANOL
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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