May is Hepatitis Awareness Month, an observance intended to remind us of the high, under-recognized hepatitis-associated disease burden in this country and of the often neglected opportunities for prevention and care. An estimated 3.5-5.3 million Americans have chronic viral hepatitis, which is a leading cause of primary liver cancer. People living with HIV are disproportionately affected by viral hepatitis and the related adverse health outcomes. Of those infected with HIV, more than 25% are coinfected with Hepatitis C and an estimated 10% with Hepatitis B. While highly active antiretroviral therapy has extended the life expectancy of HIV-infected persons, liver disease–much of which is related to Hepatitis C–has become the most common non-AIDS-related cause of death of among this population.
HIV, Hepatitis B, and Hepatitis C share common modes of transmission. People living with HIV who are also living with viral hepatitis are at increased risk for serious, life threatening complications. As a result, all persons living with HIV should be tested for Hepatitis B and Hepatitis C by their doctors. Co-infection with hepatitis may also complicate the management of HIV infection.
In order to prevent co-infection with Hepatitis B, the Advisory Committee on Immunization Practices recommends universal Hepatitis B vaccination of susceptible patients with HIV/AIDS. Hepatitis A and Hepatitis B vaccines are also recommended for all men who have sex with men, users of illicit drugs, and others at increased risk of infection. There is no vaccine for Hepatitis C.
In 2010, an interagency work group of U.S. Department of Health and Human Services (HHS) experts was created to develop a comprehensive strategic action plan to respond to the viral-hepatitis-associated disease burden. The HHS Action Plan for the Prevention, Care and Treatment of Viral Hepatitis describes opportunities to improve coordination of viral hepatitis prevention activities across HHS, and the framework needed to engage other agencies and nongovernmental organizations in prevention and care. Various strategies throughout the plan outline methods of integration of HIV and viral hepatitis in education, prevention and services. The HHS Action Plan was released last week on May 12.