Hepatitis b

Welcome to this treatment guide for HIV-positive people who also have hepatitis B (HBV). This guide provides information on
the prevention, care, and treatment of HBV, and the impact of HBV on HIV disease. It is designed to be accessible to people with
no medical training. Where medical terms are used, they are explained in detailed but simple language.
Because HIV and hepatitis viruses are transmitted in similar ways, having both HIV and hepatitis B (known as HIV/HBV
coinfection) is possible. This guide focuses on coinfection with HIV and hepatitis B, but since most of our understanding of
hepatitis B comes from research studies done in people without HIV, most of the information provided here should also be useful
for people who have HBV alone.
While people with HIV/HBV coinfection are living longer and healthier lives with effective HIV treatment, slower-progressing
liver disease caused by hepatitis B, such as liver cancer and liver failure, are now emerging as major health concerns. There are
many complicating factors in HIV/HBV coinfection that can change disease progression, depending on when you're infected with
these viruses and how long you’ve had them. These factors underscore the importance of an individual approach to your own
health care. Being informed about the range of care and treatment choices available to you may help you feel more in control of
your health-care decisions.
At the end of this guide, we have included a list of organizations that can provide support, financial assistance, and current
medical information. We have also included a glossary that defines some of the medical terms used in this guide.
Hepatitis B treatment options have greatly expanded in the last ten years, and our understanding of chronic HBV disease is likely
to change as new research findings emerge. Please check back on this website for updates.

Hepatitis c

[1]
Hepatitis C is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV). The
infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver
(fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases,
those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver
[1]
cancer or life threatening esophageal varices and gastric varices.

The hepatitis C virus is spread by blood-to-blood contact. Most people have few, if any symptoms after
the initial infection, yet the virus persists in the liver in about 85% of those infected. Persistent infection can
be treated with medication, peginterferon and ribavirin being the standard-of-care therapy. 51% are cured
overall. Those who develop cirrhosis or liver cancer may require a liver transplant, and the virus universally
recurs after transplantation.

An estimated 270-300 million people worldwide are infected with hepatitis C. Hepatitis C is only known to
cause disease in humans. No vaccine against hepatitis C is currently available. The existence of hepatitis
[2]
C (originally "non-A non-B hepatitis") was postulated in the 1970s and proven in 1989. It is one of five
known hepatitis viruses: A, B, C, D, and E.
 HIV

Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that
[1][2]
causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune
system begins to fail, leading to life-threatening opportunistic infections. Infection with HIV occurs by the
transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is
present as both free virus particles and virus within infectedimmune cells. The four major routes of
transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother
to her baby at birth (perinatal transmission). Screening of blood products for HIV has largely eliminated
transmission through blood transfusions or infected blood products in the developed world.

HIV infection in humans is considered pandemic by the World Health Organization (WHO). Nevertheless,
[3][4]
complacency about HIV may play a key role in HIV risk. From its discovery in 1981 to 2006, AIDS killed
[5] [5]
more than 25 million people. HIV infects about 0.6% of the world's population. In 2005, AIDS claimed
an estimated 2.4–3.3 million lives, of which more than 570,000 were children. A third of these deaths
[6]
occurred in Sub-Saharan Africa, retarding economic growth and increasing poverty. At that time, it was
estimated that HIV would infect 90 million people in Africa, resulting in a minimum estimate of 18
[7]
million orphans. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but
[8]
routine access to antiretroviral medication is not available in all countries.
+
HIV infects primarily vital cells in the human immune system such as helper T cells (to be specific, CD4 T
[9] +
cells), macrophages, and dendritic cells. HIV infection leads to low levels of CD4 T cells through three
main mechanisms: First, direct viral killing of infected cells; second, increased rates of apoptosisin infected
+
cells; and third, killing of infected CD4 T cells by CD8 cytotoxic lymphocytes that recognize infected cells.
+
When CD4 T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body
becomes progressively more susceptible to opportunistic infections.
[10]
Most untreated people infected with HIV-1 eventually develop AIDS. These individuals mostly die from
opportunistic infections or malignanciesassociated with the progressive failure of the immune
[11]
system. HIV progresses to AIDS at a variable rate affected by viral, host, and environmental factors;
most will progress to AIDS within 10 years of HIV infection: some will have progressed much sooner, and
[12][13]
some will take much longer. Treatment with anti-retrovirals increases the life expectancy of people
infected with HIV. Even after HIV has progressed to diagnosable AIDS, the average survival time with
[14]
antiretroviral therapy was estimated to be more than 5 years as of 2005. Without antiretroviral therapy,
[15]
someone who has AIDS typically dies within a year.
 Syphilis

Syphilis is a sexually transmitted disease caused by the spirochetal bacteria Treponema

pallidum subspecies pallidum. The primary route of transmission of syphilis is through sexual
contact however it may also be transmitted from mother to fetus during pregnancy or at birth resulting
in congenital syphilis.

The signs and symptoms of syphilis vary depending on which of the four stages it presents in (primary,
secondary, latent, and tertiary). The primary stage typically presents with a single chancre, secondary
syphilis with a diffuse rash, latent with little to no symptoms, and tertiary with gummas, neurological, or
cardiac symptoms. Diagnosis is usually via blood tests. It can be effectively treated with antibiotics,
specifically intramuscular penicillin G.

Syphilis is believed to have infected 12 million people worldwide in 1999 with greater than 90% of cases
in the developing world. Rates of infection have increased during the 2000s in many countries.