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A large number of HIV patients worldwide are also infected with either HBV, the hepatitis B virus, or HCV, the hepatitis C virus. These forms of hepatitis are often transmitted through the same methods as HIV, which may explain high rates of co-infection.
It is estimated that 6–14 percent of HIV patients in the developed world have HBV. Co-infection rates are much higher in the developing world, especially in sub-Saharan Africa. Upon initial infection with HBV, some patients experience acute symptoms, but others do not develop symptoms for several years. Acute HBV infection becomes chronic is less than five percent of the general population, but people with suppressed immune systems are much more likely to develop chronic infection.
The effects of HBV can be dramatically different from person to person. Some patients experience minor liver impairment while others suffer from cirrhosis, extensive ﬁbrosis and liver cancer. Patients with HBV-HIV co-infection are at a higher risk for liver-related death.
About 25 percent of people living with HIV in the U.S. are also infected with HCV. Co-infection rates are much higher in Europe, especially in Ukraine and Russia where intravenous drug use is the leading cause of infection for both viruses.
Like HBV, HCV can cause some people to become ill immediately following infection while other patients remain asymptomatic. Infection becomes chronic in 50-90 percent of HCV cases, and HIV significantly raises a patient's risk for chronic infection. One study of HCV patients suggests that people co-infected with HIV are six times more likely to experience cirrhosis than HIV negative individuals. Similar to HBV, the long term effects of HCV vary from patient to patient and range from minor hepatic impairment to extensive ﬁbrosis, cirrhosis and liver cancer.
Hepatitis A is transmitted through ingestion of infected fecal particles, so it is commonly spread through food prepared in unsanitary conditions or the sexual practice of analingus, or "rimming". Hepatitis D can only infect individuals who already have HBV, which is why patients who test positive for HBV should also be tested for hepatitis D.
HIV patients should get tested for all forms of hepatitis when they are first diagnosed with HIV and annually after that. Vaccines are available for hepatitis A and B, and immunization is highly recommended for HIV patients. Transmission of HBV and HCV can be prevented through the same strategies used for HIV prevention including safer sex practices and avoiding sharing needles for drug use.
All forms of hepatitis can be treated with medication. Adherence to antiretroviral therapy for HIV can reduce a patient's chances of developing complications from hepatitis; however, special care is needed when treating co-infection because of potential drug interactions and adverse effects. For example, sudden discontinuation of the antiretrovirals tenofovir, lamivudine or emtricitabine can cause hepatitis patients to suffer from life-threatening liver complications. See the European AIDS Clinical Society's guidelines for dosing recommendations in HIV-hepatitis co-infected patients for further guidance. Patients with cirrhosis should be treated by a doctor who specializes in liver disease in addition to their HIV doctor.