Hepatitis is the inflammation of the liver. The liver is the largest organ in the body, situated on the upper right side of the stomach. The liver plays a number of important roles – it cleans the blood, breaks down alcohol, drugs and helps with the general functioning of the human body. For people with HIV, the liver plays an important function in processing medicines used to treat HIV and other conditions. Viral infections such as hepatitis A, hepatitis B and hepatitis C cause the liver to malfunction and, therefore, for medicines (including ARVs) to not work properly.
Hepatitis A is the most common of the viral hepatitis but is rarely very serious. Most people become infected with Hep A when they drink or eat food that is contaminated with faeces. Personal hygiene such as hand washing can minimise the risk of the virus being transmitted. Hep A is also a sexual transmitted infection. Symptoms of Hep A include mild flu like illness, loss of appetite, weight loss, itchy skin. The infection normally clears in two months but it can persist for longer.
Hepatitis B, HBV, is similar to Hep A but is more likely to cause severe long term illness and permanent liver damage. HBV is contracted the same way as HIV, through contact with blood, semen, vaginal fluid or mother to baby. HBV can be cleared by the immune system without medicine. People with HBV may not have symptoms for many years but can still pass the disease. It is, therefore, important to practise safer sex and use condoms correctly and consistently. Once someone has had HBV and recovered, they are then immune to it. Treatment and vaccines are available for HBV.
Hepatitis C is usually transmitted through similar modes as HIV. Few people experience symptoms when infected. In the longer term, about 50 percent of people with Hepatitis C will experience some symptoms. The most common ones are feeling generally unwell, extreme tiredness, weight loss, depression and intolerance of fatty food and alcohol. Some people with Hep C will develop severe liver disease within 15-25 years. Men and people who drink alcohol progress to severe liver disease faster. People co-infected with HIV and Hep C are more likely to develop liver damage than people who are only infected with Hep C. Chronic infection with Hep C can also cause cancer. Surgery is the most effective treatment for liver cancer although other options exist such as drug treatment. Drugs are available for Hep C treatment. Hep C treatment lasts 24-48 weeks. Doctors may recommend a patient start with Hep C treatment before anti-HIV treatment so that the liver is strong enough to help with effectiveness of ARVs.