Hepatitis B
Although hep B is less common in the UK than in southern Europe or Asia, you are certainly not alone. It can have serious consequences for people living with HIV as they have a much higher risk of developing liver disease.
Your doctor will want to look at how well your liver is working. If it does not appear to be stressed by the hepatitis there may be no need for action, apart from avoiding alcohol or keeping your intake very low.
The liver function tests should be repeated every six months. If you have above normal liver enzyme levels this is a sign that hep B is beginning to damage your liver. An ‘e-antigen-positive’ result means you have higher levels of virus activity and you can pass it on more easily. If your liver enzyme levels are high, your doctor may recommend you begin treatment.
Hep B does not affect the speed at which HIV damages your immune system but it does complicate HIV treatment. The good news is, unlike HIV, hep B can be completely cleared from the body in some people. A drug called interferon-alpha is injected three times a week for six months and the side-effects are unpleasant. Future developments will hopefully improve the success rate of this treatment. Even if it can’t be cleared, treatment may reduce the risk of liver damage.
This is unclear. British HIV Association guidelines recommend the first-line treatment should contain at least one drug that is also active against hep B - either 3TC, FTC or tenofovir. However no one knows how long treatment needs to last in people with HIV in order to clear hep B.
People with raised liver enzymes due to hep B may be at higher risk of liver toxicity when they begin HIV treatment, particularly if the combination includes nevirapine or protease inhibitors. There is also a risk you will have a flare-up of hepatitis symptoms when you begin HIV treatment. This is because the immune system is rebuilding itself and responding to viruses like hep B.
Hep B is much more infectious than HIV. It can be transmitted sexually through saliva, semen and blood, and can also be caught through tattooing and piercing. It is amazing that you have never been tested or vaccinated for hep B - when did you last visit a sexual health clinic? They should have suggested that you needed the vaccination. Didn’t you go to a travel clinic before your trip to Thailand?
It is essential to have the full course. If you are telling partners about hep B, tell them to get vaccinated. It’s free at sexual health clinics. If you aren’t discussing hep B with them, do not assume that they have been vaccinated. You weren’t. The risk of transmission can be reduced by using condoms both for vaginal and anal intercourse, and for oral sex.
• NAM provides information to help you think about your use of HIV treatments, but this is not intended to replace discussion with your doctor.
Visit NAM at www.aidsmap.com
