Hepatitis and HIV

What are these infections?

Hepatitis means inflammation of the liver. Hepatitis B and C are caused by viruses. Some people get through the infection with no symptoms at all, and some develop a long-term infection that, over years, may lead to cirrhosis (a hardened, damaged liver). That is why testing and follow-up matter.

HIV is a virus that attacks the body’s immune system. If it is not treated, it can reach the stage called AIDS over the years. But the sources say that with antiviral treatment, HIV is now a manageable long-term condition.

Having one of these infections says nothing about a person’s character or behaviour, and is no reason for judgment. They are infections, and there are many ways of catching them: from medical equipment and contaminated needles, from mother to baby, from contact with blood, and sometimes through sex.

How are they passed on?

• Hepatitis B: through blood and body fluids. The WHO says the most common route is from mother to child at birth. Unsafe injections and sharp instruments, sex, and tattoos or ear piercing with unsuitable equipment are other routes.
• Hepatitis C: through blood. Unsafe injections or medical procedures, unscreened blood, and sharing injecting equipment are the main routes.
• HIV: through blood, breast milk, semen and vaginal fluids. Higher-risk routes include sex without protection, shared injecting equipment, unsafe injections or blood transfusions, and passing from mother to child.

What does not pass them on?

For all three, everyday contact carries no risk. The sources specifically say these do not cause infection:

• hugging (and shaking hands, for HIV)
• kissing (for HIV, hepatitis B and C)
• sharing dishes, cups and food
• coughing and sneezing (hepatitis B and C)
• toilets and household items (HIV)

However, do not share things that may get blood on them, such as razors and toothbrushes (NHS, for hepatitis B). This does not mean separating a person with the infection from their home and family.

Who should see a doctor?

It is a good idea to take testing and a visit seriously if:

• a test for one of these viruses was positive or unclear in the past
• you may have had contact with blood or contaminated equipment (injections, surgery or dental work in an unreliable place, tattoos, a shared razor)
• your partner or a family member has one of these infections
• you are pregnant (the sources recommend testing in pregnancy)
• your eyes and skin have turned yellow, or your urine has become dark

For hepatitis B the CDC recommends that all adults be tested at least once in their lifetime, and for hepatitis C it invites all adults to be tested.

There is nothing to be ashamed of. The doctor’s aim is to understand the illness and protect your health and that of the people around you.

How is it investigated?

These infections are identified only by tests, not by symptoms.

• Hepatitis B: blood tests to tell an acute infection from a chronic one and to measure liver damage. An ultrasound or a liver stiffness measurement is sometimes done too (WHO).
• Hepatitis C: first an antibody test, which shows that the virus entered the body at some point. If it is positive, another test (RNA) shows whether the infection is still active, because some people clear the virus on their own. Then the state of the liver is assessed.
• HIV: a rapid antibody test gives a result the same day, but a positive result must be confirmed with another test (WHO and NHS). If there was a recent high-risk contact, the test may need to be repeated after a few weeks.

What does treatment generally look like?

Hepatitis C. Treatment is with antiviral tablets. The CDC says treatments cure over 95 percent of patients, usually with no side effects, over 8 to 12 weeks (12 to 24 weeks in the WHO, depending on the liver). The NHS also says it is important to continue treatment to the end so that it works.

Hepatitis B. Acute hepatitis B usually gets better by itself. Chronic hepatitis B has no cure, but it is controlled with antiviral medicines and regular liver follow-up. The WHO says most patients need to continue treatment for life, and that treatment can slow progression to cirrhosis and liver cancer. The hepatitis B vaccine protects healthy people (WHO: close to 100 percent protection for those who complete the course).

HIV. There is no cure, but antiviral treatment lowers the amount of virus, rebuilds the immune system and allows most patients to live a long and healthy life. When the amount of virus in the blood reaches an undetectable level, the virus is not passed on through sex. The NHS says it usually takes about 6 months to reach this level. The CDC recommends starting treatment as soon as possible after diagnosis.

None of this promises a definite result. Everyone responds to treatment differently, and the patient’s own part in taking medicines regularly and attending follow-up makes a big difference.

What can you do yourself?

• Do not put off testing and follow-up. Finding it early gives you better chances. The WHO says early diagnosis and treatment of hepatitis C prevents serious liver damage.
• Take your medicine regularly and do not stop it without your doctor’s advice.
• Before any new medicine (even herbal or over the counter), ask your doctor, because some medicines harm the liver (CDC, for hepatitis B).
• Limit alcohol, eat well and stay active (CDC, for hepatitis B).
• Do not share razors, toothbrushes or other sharp items.
• Ask your doctor about the hepatitis B vaccine for yourself and your family. The CDC recommends it for babies, children and adults aged 19 to 59.
• Ask: how will my information be kept? This is your right.
• You are not alone. The NHS says an HIV diagnosis can be very worrying and hard to accept. Talking to a doctor or counsellor helps.

When to seek urgent care

Call 115 (Iran’s emergency number) or go to the emergency department if:

• you are confused, very drowsy, or your speech makes no sense
• you have very fast or difficult breathing, or blue, pale or mottled skin
• you have fever with a stiff neck and severe headache, or a seizure

If you think you were exposed to HIV in the last 72 hours (for example through a needle or contact with blood), go as soon as you can to an emergency department or a counselling centre. The NHS gives this 72-hour window and says emergency preventive treatment may stop you becoming infected. Do not wait, and do not feel shame.

In people with a weak immune system (such as untreated HIV), take a fever seriously early. The NHS lists a weak immune system as a higher-risk group for sepsis. If your eyes and skin have turned yellow or your urine has become dark, see a doctor the same day.

Every patient’s treatment plan is different. Ask your doctor about your own situation.