Viral Hepatitis Infection in People with HIV

Understand the Signs and Symptoms of Hepatitis

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Hepatitis infection is the clinical term used to describe the inflammation of the liver. The inflammation can be caused by several factors including medications, certain viruses, exposure to chemicals, environmental toxins, autoimmune disorders and alcohol use.

Within the context of HIV, there exists a high rate of co-infection with certain types of viral hepatitis, most specifically hepatitis C (HCV).

In fact, some epidemiological research suggests that as many as 20-30% of Americans with HIV also are infected with HCV.

It is, therefore, important to understand the signs and symptoms of viral hepatitis, as well as the types of viruses currently identified.

Stages of Viral Hepatitis Infection

Viral hepatitis can be broadly classified by stage of infection.

Acute infection typically occurs at or near the time of exposure to the virus. The onset of symptoms can be sudden or gradual but are most often short-lived, usually resolving within the span of two months. During this stage, liver damage is usually mild as evidenced by scarring (fibrosis) on the liver itself. Liver function is generally unimpeded and the symptoms, if any, are rarely fatal. In some cases, an acute infection may spontaneously clear, leaving no evidence of virus or damage.

Chronic infection  is that which persist over a long period of time.

Symptoms in the early part of the chronic stage may be non-specific to non-existence despite the fact that fibrosis may be advancing in the liver. During the stage, infection can be described as chronic persistent (with symptoms developing slowly and mildly) and chronic acute (when the manifestations of the disease are serious and apparent).

In those with untreated chronic infection, there is an increased risk of cirrhosis, in which the scarring of the liver is so extensive as to interfere with liver function (compensated cirrhosis) or stop it altogether (decompensated cirrhosis), resulting in liver failure.

Other manifestations of chronic acute infection include hepatocellular carcinoma, a life-threatening form of liver cancer than can only be treated with a liver transplant.

Common Signs and Symptoms of Viral Hepatitis

Symptoms of hepatitis can vary, depending on the type of virus involved, but can often include the following during acute hepatitis infection:

  • Jaundice (yellowing of the eyes and skin)
  • Choluria (darkening of the urine)
  • Fever
  • Fatigue
  • Nausea
  • Vomiting
  • Abdominal pain
  • Joint pain (arthralgia)
  • Muscle pain (myalgia)

During the chronic stage of infection, symptoms can become more pronounced, although rarely incapacitating. In many cases, they are difficult to ascribe to liver dysfunction alone. In addition to the above, he most typical symptoms of chronic hepatitis infection are:

  • Abnormal tingling or burning sensations (paresthesia)
  • An uncomfortable “pins-and-needles” sensation (peripheral neuropathy)
  • Itchy skin (pruritus)
  • Raised, bumpy areas of rash (urticaria)
  • Dry eyes accompanied by dry mouth (Sicca syndrome)

It is only when the liver is cirrhotic and its function is impaired that the symptoms become more indicative of liver disease. The signs and symptoms of compensated cirrhosis include:

  • Spider veins (spider nevi), mainly on the trunk and face
  • Itchy skin (pruritus)
  • Redness on the palms of the hands (palmar erythema)
  • Easy bruising or abnormal bleeding (variceal bleeding)
  • Build-up of fluid in the ankles and feet (edema)
  • Poor concentration and memory
  • Loss of appetite (anorexia)
  •  Weight loss
  • Shrinking testicles (testicular atrophy)
  • Erectile dysfunction or loss of libido
  • Alcohol intolerance

Decompensated cirrhosis and hepatocelllular carcinoma are both classified as end-stage liver disease.

Types of Viral Hepatitis

Currently, there are six known viruses that cause hepatitis, designated by the letters A through G. Their modes of transmission, geographic distribution and presentation can vary, as well as the options available to either prevent or treat infection.

In alphabetical order:

  • Hepatitis A (HAV), formally known as infectious hepatitis, is always acute and never become chronic. HAV is transmitted by contact with infected feces or fecal-contaminated food or water that. HAV infection is often a result of poor hand-washing  practices among food handlers. Ahepatitis A vaccine is available to prevent infection, delivered in a series of infections.
     
  • Hepatitis B (HBV), formally known as serum hepatitis is transmitted via sexual contact, saliva, shared contaminated needles, and exposure to infected blood. HBV often will progress to a chronic hepatitis without showing signs of active hepatitis. The risk of contracting Hep B can be reduced with an hepatitis B vaccine, while the Twinrix vaccine can offer protection from both HAV and HBV. 
     
  • Hepatitis C (HCV) is transmitted primarily by the shared use of contaminated syringes and needles, but can also be passed from mother to child during pregnancy and, less commonly, through sexual contact. HCV can spontaneously clear from as many as 30-40% of infected individual without any signs of symptoms. Other will progress to a chronic infection that can go undetected for years. While there is no vaccine to prevent hepatitis C, there are powerful direct-acting antivirals (DAAs) which can now deliver cure rates of up to 99% in some populations.
     
  • Hepatitis D (HDV) is a form of viral hepatitis which can only replicated by attaching to HBV. As such, it can accompany an HBV infection but not manifest on its own.
     
  • Hepatitis E (HEV) is similar to HAV and is similarly transmitted through contaminated food and water or contacted with infected feces. Once thought to be rare, increased international travel has led some experts to estimate that up to 20% of Americans could be infected.
     
  • Hepatitis F (HFV) is a theoretical virus which some believe may cause hepatitis. Despite a number of potential candidates in the 1990s, there have yet to be substantiation of the virus' existence.
     
  • Hepatitis G (HGV) is most often present in combination with hepatitis A, B or C.

Sources:

American Association for the Study of Liver Disease (AASLD). "Assessing the Global and Regional Burden of Liver Disease." Washington, D.C. Press release issued November 3, 2013.

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