Hepatitis A and Hepatitis B Vaccination
Federal guidelines recommend vaccination against hepatitis A (HAV) and
hepatitis B (HBV) for people with chronic HCV, HIV, or both.30,42-45,59 Becoming infected with another hepatitis virus has serious consequences
for people with HIV/HCV coinfection:
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HAV can cause sudden hepatic failure in people
with chronic HCV.60,61
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Coinfection with HBV and HCV has been associated
with more rapid HCV disease progression.30,62
Although vaccinations against HAV and HBV are an important part of care
for HIV and HCV, research indicates that vaccination rates are low. A
review of HAV and HBV screening and vaccination practices at nine HIV
Outpatient Study sites reported wide variability among sites. Of 1,071
patients, 57.2 percent (612) were screened for HAV, and 81.9 percent
(877) were screened for HBV, yet only 23.3 percent of those eligible
for vaccination against HAV (167 of 716) received one or more doses of
HAV vaccine, and just 32.4 percent (198 of 612) of eligible patients
received one or more doses of HBV vaccine. In HIV-positive people, vaccination
for HAV and HBV is preferable when CD4 cell counts are higher than 200/mL
because the immune response to HAV and HBV vaccination decreases at lower
CD4 cell counts.64-66
Acute HCV Infection
Acute HCV infections are often undiagnosed because only 20 percent of acutely
infected people experience symptoms, such as fever, fatigue, loss of appetite,
nausea, and vomiting.63 Diagnosing acute HCV is important, because it offers
an opportunity for improving treatment outcomes (see Treatment of Acute HCV). |