Hepatitis B (cont.)
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
In this Article
- What is hepatitis?
- How is the hepatitis B virus spread (transmitted)?
- What are the symptoms of acute hepatitis B infection?
- What are the symptoms of chronic hepatitis B infection?
- How is hepatitis B diagnosed?
- What is the role of a liver biopsy in chronic hepatitis B?
- What is the natural course of chronic hepatitis B?
- What medications are used to treat hepatitis B?
- What are the effects of alcohol on hepatitis B?
- What are the effects of immunosuppressive medications on hepatitis B?
- What is delta hepatitis?
- What about co-infection with hepatitis B virus and hepatitis C virus?
- What happens in co-infection with hepatitis B virus and human immunodeficiency virus?
- What is the role of liver transplantation in hepatitis B?
- What can be done to prevent hepatitis B?
- What is new in the treatment of hepatitis B?
- Hepatitis B At A Glance
- Find a local Gastroenterologist in your town
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.
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