Hepatitis and HIV

First of all

The CDC says shame and fear of being exposed can keep people from getting tested and treated. So here we talk about how these infections spread, how they are tested for and how they are treated, and not about how anyone got infected. Hepatitis and HIV are infections. Like any other infection, they need to be diagnosed and followed up.

HIV

WHO says HIV spreads through blood, breast milk and sexual fluids, and that a mother can pass it to her child during pregnancy or birth. Everyday contact does not spread it. The NHS states clearly that it does not spread through kissing, hugging, shaking hands, toilets, or sharing food and drink.

HIV cannot yet be removed from the body. But antiretroviral medicines suppress the virus and help keep the immune system stronger. WHO now describes HIV as a long-term condition that can be managed, and says starting treatment early matters. WHO and the CDC both say that a person who reaches an “undetectable” level of the virus on treatment does not pass it on sexually, as long as treatment is taken regularly. The NHS says this usually takes about six months.

Without treatment, the NHS says, the immune system weakens and illnesses such as tuberculosis and pneumonia can take hold. HIV can cause no symptoms for years, so a test is the only way to know. In the United States, the CDC recommends that everyone aged 13 to 64 be tested at least once.

Hepatitis B

Hepatitis B spreads through blood and body fluids. The NHS lists these routes: sex, shared needles, needle-stick injuries, tattoos, piercings or medical procedures done with unsterilised equipment, and passing from mother to baby at birth. The NHS also says razors and toothbrushes should not be shared. The CDC says hepatitis B does not spread through kissing, shared dishes, sneezing, coughing, hugging, breastfeeding, food or water.

Most adults have either no symptoms or mild ones, and the infection usually lasts one to three months and clears on its own. If it lasts more than six months, it is called “chronic”. WHO points out that infection in infancy becomes chronic in about 95% of cases, compared with fewer than 5% in adulthood. Chronic hepatitis B can cause no symptoms for decades, but the CDC warns that without follow-up it can lead to liver damage, cirrhosis and liver cancer. That is why people with chronic hepatitis B need regular check-ups.

The main way to prevent it is the vaccine. The NHS says the same, and WHO says that once the vaccine course is complete, protection lasts at least 20 years and probably for life. There is no vaccine for hepatitis C.

Hepatitis C

Hepatitis C is a blood-borne virus. WHO says most cases come from contaminated medical equipment, reused syringes, unscreened blood transfusions and shared injecting equipment. Spread from mother to baby or through sex is less common. WHO, the NHS and the CDC all say hugging, kissing and sharing food and drink do not spread it.

Most people have no symptoms for years. WHO says diagnosis has two steps: first an antibody test, and if that is positive, an RNA test for the virus, which shows whether the infection is active. The second step matters, because some people clear the virus on their own and their antibody test stays positive.

The good news is that hepatitis C can be cured. The CDC and WHO say antiviral medicines cure more than 95% of patients and cause few side effects. The NHS also stresses that the full course must be completed. The CDC reminds us that it is possible to be infected again after treatment.

Who should be tested?

In the United States, the CDC recommends testing for the groups below. Your doctor should decide based on your own situation.

• HIV: everyone aged 13 to 64, at least once.
• Hepatitis B: all adults at least once, and pregnant women in every pregnancy.
• Hepatitis C: all adults, pregnant women, and anyone who has recently been exposed to the virus.

WHO says that partners and family members of a person with hepatitis B, health workers, and people with HIV are among the groups for whom hepatitis B testing is a priority. WHO estimates that about 7.4% of people with HIV also have hepatitis B.

What do the tests tell you?

• HIV: a rapid test gives a result the same day. WHO says a positive result must be confirmed with a follow-up test. If the exposure was recent, a negative result may be repeated later.
• Hepatitis B: WHO says symptoms alone are not enough for a diagnosis, and a blood test is needed. Blood tests tell acute infection from chronic infection. Ultrasound and elastography measure the amount of fibrosis (scarring) in the liver.
• Hepatitis C: an antibody test, then an RNA test. The NHS says that if the infection may be recent, a negative result might be repeated after six months.

So the first result is not always the last word. Your doctor will help you interpret it.

What does treatment look like in general?

• HIV and hepatitis B: treatment is medicine plus regular follow-up. WHO talks about “support for staying on treatment”, and says that for hepatitis B most people who start treatment must continue it for life. Do not stop or change your medicine yourself. If you have side effects or cannot tolerate the medicine, tell your doctor the same day. If you get a rash, trouble breathing, or swelling of the face or throat, do not wait: call 115.
• Hepatitis C: a set course of antiviral tablets. The NHS says tests after treatment check whether the virus is gone. If the treatment did not work, a different medicine is offered.
• Look after your liver too. The NHS says that for hepatitis C your specialist may also advise a healthy weight, stopping smoking, and avoiding or cutting down on alcohol.
• Pregnancy. WHO says a pregnant woman with HIV should start treatment as early as possible, because this also prevents passing the virus to the baby. If you are pregnant or planning a pregnancy, tell your doctor early. With hepatitis B too, the baby should be vaccinated as soon as possible, within the first 24 hours (WHO). If you have hepatitis B, tell your doctor before the birth.

Family and people around you

None of these infections spreads through living together, eating together or hugging. Razors, toothbrushes and other sharp items should not be shared. If someone at home has hepatitis B, their partner and family should talk to a doctor about testing and vaccination (WHO, NHS). The NHS says sexual partners who may have been exposed should be told, and the treatment team can offer advice on how to have that conversation.

Your results and your privacy

Who gets to know about your health is something you have a right to ask about. This website makes no promise about how patient information is handled. Ask at the visit or before the test.

When to act right away

• Yellow eyes and skin, dark urine, nausea and vomiting, and pain in the upper abdomen are signs of hepatitis. WHO says severe acute hepatitis can lead to liver failure. See a doctor the same day.
• If you may have been exposed to HIV in the last 72 hours, the NHS says emergency preventive medicine exists. Contact a doctor as soon as possible, at once, and if you cannot reach them, go to a hospital emergency department. The same goes for a needle-stick injury.
• The NHS points out that people with weakened immunity, including people with HIV, are more at risk of sepsis. For fever, severe chills, confusion or fast breathing, see the list of urgent signs and call 115, Iran’s emergency number.

This page is for information only and does not replace an examination.