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.
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.
Straight Arrows, Victoria’s lead agency for heterosexual people living with HIV, provides more detailed information on HIV and HEP C co-infection.
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.