Hepatitis is an irritation or inflammation of the liver. The term is commonly used to refer to several specific viral infections, including hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV). It is estimated that about 25 percent of HIV patients are also infected with HBV. Non-viral hepatitis is a common side effect of many drugs that are used to fight HIV.
Viral hepatitis is usually diagnosed with a blood test. This highly infectious disease can be transmitted readily between sex partners, among people living in the same household, and among drug users who share needles. It is important that HIV patients are tested for viral hepatitis so that measures can be taken to prevent the disease from developing.
Hepatitis A (HAV) usually is not a serious illness. Symptoms include fever, jaundice (yellowing of the skin and eyes), nausea, diarrhea, fatigue, abdominal pain, dark urine, vomiting, and a loss of appetite. It is transmitted by oral-fecal contact and through contaminated water or food.
HAV can be prevented with vaccination, by maintaining good personal hygiene, and by practicing safer sex. Immune globulins (IG) are sometimes used to prevent HAV, but they are only effective for about 3 to 6 months, depending on the dose. IG is also used as a post-exposure prophylaxis, that is, for patients who have been exposed to HAV and have not been vaccinated.
There is no treatment for HAV. Fortunately, the infection is usually self-limiting, meaning that it goes away on its own without any treatment. Plenty of rest and a low-fat, low-protein diet can help.
In most cases, people contract hepatitis A only once in their lifetime. Rarely, patients who are infected with HAV develop a severe form of hepatitis called "fulminant hepatitis," which if left untreated, can be fatal.
Anyone who may have been exposed to HAV should see a physician or other health care provider. Patients who have HIV should be tested for HAV and if they have not been exposed to the virus, they should receive the HAV vaccine.
Hepatitis B (HBV) is transmitted through sexual contact, through contact with infected blood, by sharing contaminated needles, and from mother to infant. Many patients with HIV are co-infected with HBV. Practicing safer sex and not sharing drug injection equipment provide protection against both HIV and HBV.
HBV causes an initial acute illness, very much like hepatitis A. Symptoms include fever, jaundice, and severe fatigue. The illness usually lasts for a week and can last as long as a month. About 10% of patients develop chronic infection. Not only can patients transmit the virus to others, but they also are at risk for developing serious chronic liver disease. People infected with HIV are at increased risk for developing chronic HBV.
There are two general types of chronic HBV. Persistent chronic HBV does not produce major symptoms. Chronic active HBV is a very aggressive infection that can cause cirrhosis and liver cancer. Patients who have either type can transmit the virus to others.
HBV can be prevented by practicing safer sex, by avoiding contact with the blood of infected patients, by not sharing drug injection equipment, and by receiving a vaccination. All patients with HIV should be tested for HBV. If they have not been exposed to the virus, they should receive an HBV vaccine.
Other than trying to prevent it through vaccination, there is no standard therapy for HBV at this time. Studies have shown that interferon alfa-2b is effective at treating HBV in about 40% of cases in the general population and is even less effective in patients with HIV. Interferon is applied subcutaneously (under the skin) or into the muscle 3 times a week for 4 months or longer, and many patients experience side effects. Studies have shown that lamivudine (3TC, Epivir), famcyclovir, and adefovir dipovoxil may help reduce HBV levels in the blood and restore liver function.
Patients who have chronic HBV should visit a health care provider regularly. All patients with HIV should be tested for hepatitis B infection and should receive the hepatitis B vaccine if they have not been exposed to the virus.
Hepatitis C (HCV) is a very serious, potentially life-threatening infection. HCV is transmitted through sexual contact, through contact with blood from an infected person, by sharing needles, and from mother to infant. The initial symptoms of HCV are very similar to those for other viral hepatitis infections, although they tend to be milder. They include fever, fatigue, muscle and joint pain, nausea and vomiting, and jaundice. Only about 25% of patients who are infected with HCV show initial symptoms. Yet, HCV is a much more serious disease than either HAV or HBV, especially for patients who co-infected with HIV and HCV.
Hepatitis C occurs in approximately 1.8 percent of the general population and has been reported to occur in 12-90 percent of patients with HIV. People who are exposed to HIV through injecting drugs are much more likely to contract the disease. The progression of hepatitis C to cirrhosis is more rapid in HIV-infected patients who drink alcohol. Patients with HCV should avoid drinking alcohol.
Active hepatitis B or HAV infection speeds the progression to cirrhosis in patients with hepatitis C. Patients with hepatitis C should be vaccinated against hepatitis A and B, if they have not already been exposed to it.
Like HBV, HCV can become chronic. Indeed, most HCV cases are chronic. It is estimated that as many as 85% of patients who are infected with HCV develop a chronic infection, and as many as 70% of patients with HCV develop some type of chronic liver disease. Patients with HIV develop serious liver problems more quickly than people who are not infected with HIV and are more likely to die from sudden liver failure.
Unlike HAV and HBV, there is no vaccine against HCV. To prevent transmission, people should practice safer sex and should not share drug injection equipment. Like HIV, HCV evolves and develops resistance very quickly, making treatment a difficult challenge. Most physicians prescribe a combination of drugs, which may include one or more types of interferons coupled with ribavirin.
Several studies are being done in an effort to find a better treatment for HCV. All patients who are chronically infected with HCV should visit their doctor or other health care professional regularly.
Shingles is a very painful skin rash that is caused by the same herpesvirus that causes chickenpox (varicella zoster). Like other herpesviruses, there is an initial infectious stage, followed by a dormant stage, and then, the virus may become active again, sometimes decades later. The initial infectious stage manifests as the chickenpox, and the later flare-up is shingles. Only people who have had chickenpox or the chickenpox vaccine can develop shingles.
Patients with HIV are much more likely to develop shingles than people who are not infected with HIV. Shingles is often an early sign of immune deficiency, but it can occur at any time, and at any T-cell count, even after starting antiretroviral therapy.
A shingles outbreak typically starts as very painful belt-like rash on one side of the body, usually on the chest, back, forehead, or in the eye. A couple of days later, another rash usually appears on the skin area where the infected nerve is inflamed (herpes zoster lives in nerve tissue). The rash is made up of small blisters that crust over.
The virus can be transmitted if the blisters break open. This does not mean that shingles is transmitted; rather, people who have never had chickenpox or the chickenpox vaccine could catch the chickenpox.
Rarely, shingles can spread to internal organs and cause serious complications. In most cases, it goes away within a couple of weeks. Some patients develop a painful, chronic condition called postherpetic neuralgia that may last months or even years.
Patients who have shingles should see a physician or other health care provider. Shingles and postherpetic neuralgia can be treated successfully. The same medications that are used to treat herpes can be used to treat shingles, including famciclovir, valacyclovir, and acyclovir.
The drugs are generally prescribed in larger doses for shingles and they should be started as early as possible so as to shorten the course of infection and prevent development of postherpetic neuralgia. Low doses of some antidepressants (e.g., amitryptaline) or antiseizure medications (e.g., carbamazepam, gabapentin) also may be used to prevent or treat postherpetic neuralgia.
Anyone with shingles near the eye should see a health care provider immediately to prevent permanent eye damage. For additional information on shingles or postherpatic neurolgia, go to dermatologychannel.net.
Mycobacterium Avium Complex
Mycobacterium avium complex (MAC) is a very serious illness caused by Mycobacterium avium, a bacterium commonly found in water, soil, and some animals. MAC rarely develops in patients with a CD4+ count greater than 100 cells per cc and is most common in patients with counts below 50. MAC can be limited to one part of the body or can spread throughout the body (called disseminated MAC, or DMAC). Parts of the body that are most commonly affected include the lungs, lungs, intestines, bone marrow, liver, and spleen.
Symptoms include fever, chills, diarrhea, weight loss, stomach ache, fatigue, and anemia (low number of red blood cells). Although these symptoms are common for many AIDS-related illnesses, if a patient with a CD4 count below 100 experiences fever, anemia, diarrhea, and weight loss, it is assumed that he or she has MAC until proven otherwise. This is especially true for patients who are not on antiretroviral therapy and those who have just started therapy. When MAC spreads through the body, it can cause serious complications such as blood infections, hepatitis, and pneumonia.
Fortunately, MAC is rare in patients who are on antiretroviral therapy. Most newly diagnosed infections occur in patients who are not receiving antiretrovirals or who have recently started therapy.
Since MAC can develop resistance to antibiotics, in the same way that HIV can develop resistance to antiretrovirals, MAC treatment usually involves a combination of antibiotics such as clarithromycin, ethambutol, and rifabutin. These drugs can interact with the medications used to treat HIV, so patients with MAC should be treated by health care providers who have thorough up-to-date knowledge about HIV treatment. Patients with CD4 counts below 75 should talk to their doctors about prophylaxis to prevent MAC.
About half of the general population and 90% of patients with HIV/AIDS harbor a virus known as cytomegalovirus, or CMV. As with all opportunistic infections, people do not get sick from it unless their immune system is seriously compromised. Patients with HIV/AIDS are at risk for developing CMV when their CD4 count falls below 100 cells per cc.
CMV most commonly affects the eye. CMV retinitis is an inflammation of the retina. The initial symptom of CMV retinitis is "floaters," moving black spots in the field of vision. Patients who have a CD4 count below 200 and experience vision problems should contact their physician or other health care provider immediately. An ophthalmologist (an eye specialist) should be able to diagnose CMV upon examination. If left untreated, CMV retinitis can lead to blindness within 2 weeks.
Thankfully, CMV is rare among patients who are on antiretroviral therapy. It is usually diagnosed in patients who are not taking antiretrovirals or who have recently begun therapy.
Patients who have CMV should discuss the advantages and disadvantages of various treatment options with their physician or other health care provider. Treatment may involve intravenous (IV) administration of medications such as ganciclovir (Cytovene) or foscarnet (Foscavir), oral medications, or the surgical placement of a ganciclovir implant in the eye. Although not a cure, medication often can control the infection. As with all HIV-related infections and illnesses, antiretroviral therapy is an essential part of treatment. Antiretrovirals can prevent infection from spreading, and can help the immune system fight an existing infection.