Hepatitis B (cont.)
What about co-infection with hepatitis B virus and hepatitis C virus?
Hepatitis C is caused by a virus that is spread through
contaminated needles or blood products and, less commonly, through sexual
intercourse. About 10% of patients with chronic hepatitis B also are co-infected
chronically with hepatitis C virus (HCV). The two viruses interfere with each other and one
usually predominates. If hepatitis C is the predominant infection, treatment is
directed against the hepatitis C. Patients infected with both viruses are at
higher risk for complications of liver disease. There is no effective vaccine
against hepatitis C. Persons with hepatitis C should be vaccinated against
hepatitis B to prevent co-infection.
What happens in co-infection with hepatitis B virus and HIV?
The human immunodeficiency virus (HIV) and hepatitis B virus are transmitted
in similar ways, and it is not uncommon for an individual to have both
infections. Persons with HIV who acquire hepatitis B are more likely to become
chronically infected with hepatitis B than persons who do not have HIV. The
reason for this is thought to be that HIV suppresses the immune system and
impairs the ability of the body to eliminate the hepatitis B virus. Some
nucleoside/nucleotide analogues (a class of antiretroviral drugs)
are used to treat both HIV and hepatitis B, although dosages may vary in the two
different infections. Stopping one of these agents when the HIV regimen is adjusted may
cause hepatitis to flare.
What is the role of liver transplantation in hepatitis B infection?
Liver transplantation has been successful in patients who
have irreversible, life-threatening complications of hepatitis B. This includes
patients with liver failure due to end-stage cirrhosis or unusually severe
(fulminant) hepatitis. Liver transplantation does not cure hepatitis B, and
hepatitis may occur in the new liver. The incidence of recurrent hepatitis has
been reduced to less than 10% through use of lamivudine and HBIG in transplant
recipients. Use of these
agents has also improved long-term survival, with 75% to 85% of patients alive
after five years.
Next: What can be done to prevent hepatitis B? »
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