Hepatitis:
Hepatitis Hotline: 954-759-5456:
People with HIV-AIDS are also at high-risk for also catching Hepatitis. The same transmission routes for HIV are also the transmission routes for Hepatitis. But Hepatitis can be a lot easier to catch than HIV because the Hepatitis virus can live up to 7 days out side the body. 30% of all People with HIV are also coinfected with Hepatitis-C.
Hepatitis means inflammation of the liver. Heavy alcohol use, toxins, certain medications, bacterial infections, and some diseases can cause hepatitis. Hepatitis also refers to a group of viral infections that affects the liver.
There are basically three different, contagious liver diseases caused by three unrelated viruses, A, B, and C. Although all three types of hepatitis can cause similar symptoms, they have different modes of transmission, different prevention methods, and different treatment therapies. There are vaccinations available for Hepatitis-A and Hepatitis-B, but there is NO vaccination for Hepatitis-C.
Both Hep-A and Hep-B vaccinations have proven safe and effective and you can get them at the same time – it’s easy. Hepatitis-A requires 2 shots and Hepatitis-B requires 3 shots. You need to complete all the shots to become vaccinated, but it’s never too late too finish the series if you miss a shot.
Most health plans will pay for Hepatitis A and B vaccines for adults at high-risk. Both Gay men and HIV Positive people are high-risk. If you don’t have insurance or your insurance will not cover these vaccines, The Broward County Health Department will provide them for free. Just call the Hepatitis Hotline, tell them you are at high-risk and make an appointment.
From Monday to Friday, they offer the vaccines at 5 different locations through out Broward County depending on the day of the week.
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HAV
Hepatitis A
Testing is available for Hep-A.
The Hep-A Vaccine is 2 shots and you need to complete both shots for the vaccination to work. The second shot is done 6-months after the first shot.
How do you get it: Oral contact with feces from an infected person.
– Eating food prepared by an infected person who did not clean hands properly
– Drinking contaminated water
– Eating raw contaminated shellfish
– Close personal contact (including sex and sharing a household)
– Oral-anal sexual practices
How do you prevent it: Get vaccinated
– Wash your hands after using the bathroom, after changing a diaper, and before preparing or eating food.
– Avoid sexual practices that result in oral-anal contact, or use a latex barrier between the mouth and anus.
– cook shellfish thoroughly
What are the Symptoms: In many cases symptoms may be absent or very mild. If present, may include any of the following.
– Yellow skin or eyes (jaundice)
– Feeling very tired
– Abdominal pain
– Loss of appetite
– Nausea
– Diarrhea
How do you treat it:
– No treatment except management of symptoms
– Rest
– Don’t drink alcohol – it can worsen liver disease
– Eat a healthy diet
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HBV
Hepatitis B
Hepatitis B is 100 times easier to get than HIV because the Hepatitis-B virus can live outside the body for up to 7 days.
There are 250,000 – 300,000 new Hepatitis-B infections in the USA every year and 4,000-5,000 deaths.
The Hepatits-B vaccine is 3 shots, and you need to complete ALL 3 shots for the vaccination to work. The second shot is done 1-month after the first shot and the 3rd shot is done 6-months after the first shot.
How do you get it: Contact with infected person’s blood/body fluids.
– Sharing injection drug or tattooing equipment
– Unprotected anal, vaginal, or oral sex
– Infected mother to her infant during pregnancy, delivery or breast feeding
– Household contact
– Occupational exposure through needle stick
How do you prevent it: Get vaccinated
– Don’t share needles to inject drugs, tattoing equipment, razors, or toothbrushes.
– Wear a condom every time you have sex
– Pregnant women screened for HBV and routine vaccination for all infants
– Use standard precautions in occupations which involve possible exposure to blood and body fluids.
What are the Symptoms: In many cases symptoms may be absent or very mild.
– Most children and many adults don’t have symptoms
– Symptoms, if present are similar to Hepatits A
How do you treat it:
– Medications are available for chronic illness
– Don’t drink alcohol – it can worsen liver disease
– Get vaccinated for Hepatitis A
– Eat a healthy diet
– Regular exercise
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HCV – The Silent Epidemic
Hepatits C
Hepatitis C is at epidemic levels worldwide and in the USA. It’s estimated that there are 4,500,000 people infected with Hep-C in the USA (that’s 4 times the number infected with HIV), and 75% of these are undiagnosed. 2,700,000 of those are chronic cases. Worldwide, 170,000,000 people are infected with Hep-C.
In the USA, there are between 35,000 – 185,000 new infections per year and 85% of them are chronic.
Hepatitis C is responsible for 8,000 – 10,000 deaths in the USA each year. There is NO vaccination for Hep-C, but there is treatment, although it is very intense, lasts for 48-52 weeks, and only works 50% of the time.
How do you get it: Contact with an infected person’s blood.
– Sharing injection drug or tattooing equipment
– Blood transfusion before 1992
– Infants born to a mother with HCV
– Occupational exposure through needle stick
– Can be passed during sex, but this is not common
How do you prevent it: There is NO vaccine.
– Avoid sharing injection drug equipment
– Don’t share tattooing equipment, razors, toothbrushes, or fingernail clippers.
– Use standard precautions in occupations which involve possible exposure to blood.
– Wear a condom every time you have sex.
What are the Symptoms: In many cases symptoms may be absent or very mild.
– Most people don’t have symptoms
– Symptoms, if present are similar to Hepatitis A.
– Might not show any symptoms until 10-30 years after getting infected
How do you treat it:
– Medication are available to treat chronic illness.
– Don’t drink alcohol – it can worsen liver disease
– Get vaccinated for Hepatitis A and Hepatitis B
– Eat a healthy diet
– Regular exercise
POZitive Attitudes 
World Hepatitis Day, July 28 – “This is hepatitis!”
Hepatitis C and HIV co-infection
Approximately 350,000 people (35% of patients) in the USA infected with HIV are coinfected with the hepatitis C virus, mainly because both viruses are blood-borne and are present in similar populations. HCV is the leading cause of chronic liver disease in the USA. It has been demonstrated in clinical studies that HIV infection causes a more rapid progression of chronic hepatitis C to cirrhosis* and liver failure. No vaccine against hepatitis C is currently available. This is not to say treatment is not an option for those living with coinfection. There are six major genotypes of the hepatitis C virus.
TRANSMISSION : The hepatitis C virus is transmitted by blood-to-blood contact. In developed countries, it is estimated that 90% of persons with chronic HCV infection were infected through transfusion of unscreened blood or blood products or via injecting drug use or sexual exposure. In developing countries, the primary sources of HCV infection are unsterilized injection equipment and infusion of inadequately screened blood and blood products. There has not been a documented transfusion-related case of hepatitis C in the United States for over a decade, as the blood supply is vigorously screened with both EIA and PCR technologies. Although injection drug use is the most common route of HCV infection, any practice, activity, or situation that involves blood-to-blood exposure can potentially be a source of HCV infection. The virus may be sexually transmitted, although this is rare, and usually only occurs when an STD that causes open sores and bleeding is also present and makes blood contact more likely. According to Centers for Disease Control, hepatitis C virus is spread by exposure to large quantities of blood, either through the skin or by injection.
Sexual activities and practices, Those who currently use or have used drug injection as their delivery route for drugs, Blood transfusion, blood products, or organ transplantation prior to implementation of HCV screening (in the U.S., this would refer to procedures prior to 1992), inadequately or improperly sterilized medical or dental equipment, through accidental exposure to blood through needle sticks or blood spatter to the eyes or open wounds at work, Contact sports and other activities, such as “slam dancing” that may result in accidental blood-to-blood exposure, Tattooing dyes, ink pots, stylets, and piercing implements, Personal care items such as razors, toothbrushes, cuticle scissors, and other manicuring or pedicuring equipment.
Acute hepatitis C refers to the first 6 months after infection with HCV. Most people suffer no symptoms upon infection but for those who do the main symptoms are generally mild and nonspecific, and rarely lead to a specific diagnosis of hepatitis C. Symptoms include decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms. The virus is usually detectable in the blood by PCR within one to three weeks after infection, and antibodies to the virus are generally detectable within three to 15 weeks. Treatment during the acute infection phase has much higher success rates (greater than 90%) with a shorter duration of treatment
Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months. Clinically, it is often asymptomatic, and it is mostly discovered accidentally. Recent data suggest that among untreated patients, roughly one-third progress to liver cirrhosis* in less than 20 years. Another third progress to cirrhosis* within 30 years. The remainder of patients appear to progress so slowly that they are unlikely to develop cirrhosis* within their lifetimes. Chronic hepatitis C Infection with the hepatitis C virus causes inflammation of the liver and a variable grade of damage to the organ that over several decades can lead to cirrhosis*
The morbidity and mortality caused by HCV has increased since the inception of highly active antiretroviral therapy (HAART) because HIV patients are living longer from potent antiretroviral therapies and prophylaxis of traditional opportunistic infections. The effect of HCV on the natural history of HIV remains inconclusive due to contradictory studies documenting no effect, while others show an increase to an AIDS defining illness or death. Reduced HCV antibody production, drug interactions**, other causes of liver disease, differing epidemiologic characteristics and natural history complicate the management of HCV/HIV patients. Until recently there was little data published regarding treating HIV–HCV co-infected patients; fortunately recent trials have been published about the safety and efficacy of current treatment options.
In HIV–HCV co-infected patients, the Hepatitis C (HCV) viral load is higher than in HCV-mono-infected patients in both the plasma and liver tissue. Patients who are HIV-positive are commonly co-infected with HCV due to shared routes of transmission: percutaneous exposure to blood, sexual intercourse. Infection with HCV can be asymptomatic, self-limiting, or progress to cirrhosis or cancer.
The primary objective of HCV therapy is permanent eradication of the virus. The secondary potential benefit of eradication is a reduction in the risk of liver failure and liver cancer. Currently, (PEGASYS)peginterferon alfa-2a plus RIBAVIRIN is the only FDA approved treatment** for HIV–HCV co-infected patients Current treatment is a combination of pegylated interferon-alpha-2a or pegylated interferon-alpha-2b (brand names Pegasys or PEG-Intron) and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on hepatitis C virus genotype. Interferons bind to specific cell surface receptors of virus-infected cells, which induces a complex cascade of protein-protein interactions and a rapid activation of gene transcription. The antiviral effects of interferons are mediated through inhibition of viral penetration or uncoating, inhibiting viral replication or translation of viral proteins, and/or viral assembly and release. The difference between peginterferon and interferon is the addition of a polyethylene glycol (PEG) polymer. The addition of PEG decreases plasma clearance considerably, protects the molecule from proteolytic degradation and reduces its immunogenicity. Peak concentrations are approximately 1.5-2 fold higher than trough concentrations and the half-life is 80 hours (compared to 5.1 hours for interferon alpha-2a). Ribavirin inhibits the replication of a wide range of RNA and DNA viruses. The hepatitis C virus induces chronic infection in 50%-80% of infected persons. Approximately 50% of these do not respond to therapy. There is a very small chance of clearing the virus spontaneously in chronic HCV carriers (0.5% to 0.74% per year). However, the majority of patients with chronic hepatitis C will not clear it without treatment. The treatment may be physically demanding, particularly for those with a prior history of drug or alcohol abuse. It can qualify for temporary disability in some cases. A substantial proportion of patients will experience a panoply of side effects ranging from a ‘flu-like’ syndrome (the most common, experienced for a few days after the weekly injection of interferon) to severe adverse events including anemia, cardiovascular events and psychiatric problems such as suicide or suicidal ideation.
*Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules and loss of liver function. Cirrhosis is most commonly caused by alcoholism, hepatitis B and C. Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis, and is associated with a poor quality of life, increased risk of infection, and a poor long-term outcome. Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma) and bleeding from esophageal varices. Cirrhosis is generally irreversible, and treatment usually focuses on preventing progression and complications. In advanced stages of cirrhosis the only option is a liver transplant. Cirrhosis caused by hepatitis C is the most common reason for liver transplant. Can be diagnosed with serologic assays that detect hepatitis C antibody or viral RNA. The enzyme immunoassay, EIA-2, is the most commonly used screening test in the US.
**In May 2011, the Food and Drug Administration approved 2 drugs for Hepatitis C. The first one is boceprevir and the other is telaprevir (Incivek). Both drugs block an enzyme that helps the virus reproduce. The drugs are intended to improve on standard treatments using the injected drug pegylated interferon alpha and the pill ribavirin. The new treatment does not currently work with the HIV drug Sustiva (found in Atripla).
Hepatitis continues to be a scourge in the developed world despite all attempts to contain the spread of the hepatitis viruses, as the recent case of the traveling lab technician David Kwiatkowski, who infected 30 people with the hepatitis C virus in various hospitals, has demonstrated. The causative agents of viral hepatitis are the hepatotropic viruses as well as some others like the Epstein-Barr virus (EBV) and the Cytomegalovirus (CMV). Among these, the incidence of hepatitis caused by the hepatotropic viruses is greater. The transmission of the viruses, their symptoms, progression of the disease, and treatment, all vary depending on which type a person gets infected with. `
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