Hepatitis

WHAT IS HEPATITIS?

Hepatitis means inflammation, or swelling, of the liver. Viruses, alcohol, drugs (including prescription medications), or poisons can cause hepatitis. So can opportunistic infections (OIs) such as Mycobacterium Avium Complex (MAC) or Cytomegalovirus (CMV).

Hepatitis is a very common disease. It can affect people even if their immune systems are healthy. Hepatitis can lead to serious scarring (cirrhosis) of the liver and liver failure, which can be fatal.

Many cases of hepatitis are not treated because people either do not feel sick at all or they have not been tested and do not know they have hepatitis. The most common symptoms are loss of appetite, fatigue, fever, body aches, nausea and vomiting, and stomach pain. Some people may have dark urine, light-colored bowel movements, and a yellowing of the skin or eyes (jaundice).

Your healthcare provider will check your blood to see if your liver is working normally. These liver function tests measure the amounts of certain chemicals: bilirubin, AST, and ALT (or SGOT and SGPT). High blood levels can be a sign of hepatitis. Blood tests also look for the viruses that can cause hepatitis. Testing for hepatitis is recommended for all people with HIV.

VIRAL HEPATITIS

Scientists know about five viruses that can cause hepatitis. They are called hepatitis A, B, C, D, E, and G viruses, or HAV, HBV, and so on. Over 90% of cases of hepatitis are caused by hepatitis A, B, or C.

Viral hepatitis can be acute or chronic. Acute means that the disease only lasts for a few weeks or months then the body gets rid of the infection. You may feel sick for a couple of weeks. Chronic hepatitis means that the liver might be inflamed for six months or more. Chronic hepatitis stays in your body, you can infect other people, and your disease can become active again.

Hepatitis A (HAV) and E (HEV) are both acute infections. They are spread by contact with fecal matter, either directly or from water that has sewage in it, or through food handled by someone with contaminated hands. HAV can also be transmitted sexually, particularly during activities such as rimming. HAV and HEV do not cause chronic illness. A vaccine can prevent HAV infection.

Hepatitis B (HBV) is the most common hepatitis virus. It can be transmitted from mother to infant, through sexual contact, or through contact with infected blood. A vaccine can prevent HBV infection. Globally, about 10% of people with HIV also are infected with HBV. People with HIV are much more likely to develop chronic cases of HBV. HBV is more serious in people with HIV, but some HIV drugs treat both HIV and HBV.

Hepatitis C (HCV) is usually spread by direct contact with blood, usually through sharing needles and other injection equipment. Although it doesn’t happen as often, some people—especially men who have sex with men (MSM) with HIV—have been infected with HCV from unprotected sex. HCV can be very mild or show no symptoms, but over 15-50 years can cause serious liver damage in about 20% of people. HIV worsens HCV. There is no vaccine for HCV. New HCV medications can cure HCV infection in many people with chronic infection. Read more about HCV and HIV.

Hepatitis D (HDV) only shows up in people who get HBV. People with HIV who get HDV are more likely to get sick than people who just have HBV.

PREVENTION AND TREATMENT

The best way to prevent viral hepatitis is through cleanliness and by avoiding contact with blood. You may not know if someone else is infected. Condoms can help prevent transmission of HBV and HCV. There are vaccines that can protect you against developing HAV and HBV, even if you’ve already been exposed to them. These vaccines may not work as well for people with CD4 cell counts below 350 cells/mm³.

There are no treatments for HAV and HEV, but they usually only last a couple of weeks. Three drugs used to treat HIV–lamivudine (Epivir), tenofovir DF (Viread), and emtricitabine (Emtriva)–also help treat HBV and HDV. Adefovir (Hepsera) and tenofovir DF (Viread) are approved in the U.S. to treat HBV.

Several direct acting antivirals (DAAs) have been approved for the treatment of HCV. These DAAs cure HCV in the majority of people. Read more about drug treatments for HCV.

OTHER TYPES OF HEPATITIS

Hepatitis caused by alcohol, drugs, or poisons leads to the same symptoms as viral hepatitis. Some medications used to fight HIV or related diseases can cause hepatitis. So can the common painkiller acetaminophen (Tylenol).

If hepatitis is caused by an OI related to AIDS, then the OI has to be controlled so that the liver can heal.

MEDICATION PROBLEMS

The liver needs to be working properly to break down most drugs. Drugs that didn’t cause you any problems when your liver was healthy can make you very sick if you have hepatitis. This is also true for alcohol, aspirin, herbs, and recreational drugs.

Be sure your healthcare provider knows about all medications, vitamins, and supplements you are taking.

Some medications to treat hepatitis interact with antiretroviral medications (ARVs). Your healthcare provider or pharmacist will have to check carefully to see which drugs can be taken together.

MORE INFORMATION

CDC: Viral Hepatitis

NIH National Institute of Diabetes and Digestive and Kidney Diseases: Hepatitis (Viral)

CDC: People Coinfected with HIV and Viral Hepatitis

HIV.gov: Hepatitis B Virus Infection

HIV.gov: Hepatitis C Virus Infection

HIV.gov: HIV and Hepatitis B and Hepatitis C Coinfection

Avert: HIV AND HEPATITIS C

MedlinePlus: Hepatitis C

Reviewed July 2024

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