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Hepatitis A
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‘Hepatitis’ means inflammation of the liver.

The liver is the largest internal organ in your body. It is located at the upper right-hand side of the abdomen. Having a healthy liver is important for everybody, but it is especially important for people with HIV. The liver plays a vital part in processing medicines used to treat HIV and other conditions. Viral infections that affect the liver, such as hepatitis A, hepatitis B and hepatitis C, can make you ill and also mean that the liver is unable to process medicines properly.
What your liver does

Your liver has four major functions:

    •    It stores and detoxifies your blood, filtering out unwanted substances.
    •    It makes a substance called bile, which is released into your gut and helps you digest fat.
    •    It processes nutrients from foods, releasing energy into your bloodstream, and storing vitamins and minerals.
    •    It manufactures proteins and certain vitamins.

What can go wrong with your liver?

Drinking a lot of alcohol over a long period of time can damage your liver, leaving it permanently scarred and unable to work properly.
Certain recreational drugs, such as heroin, cocaine and ecstasy can also damage your liver.

Medicines used to treat illnesses and infections, including some HIV drugs, can also affect your liver, causing inflammation. Inflammation of the liver is known as hepatitis.

Viruses can also cause this inflammation, and therefore damage to, the liver. This booklet gives detailed information on these viruses – chiefly hepatitis B and hepatitis C – which can cause serious long-term or chronic illness. Information is also included on hepatitis A, which can make you unwell, but only in the short term.

Liver disease: fibrosis and cirrhosis

You’ll have regular blood tests to monitor the health of your liver as part of your routine HIV care. Increases in certain enzymes can indicate that the liver isn’t working properly, or is being damaged.
Excessive drinking, drug use, and having hepatitis B or hepatitis C can all damage the tissue in your liver. Two terms are used to describe this – fibrosis and cirrhosis.

If your liver has fibrosis, this means that part of it has been hardened and scarred. Fibrosis can be reversed if the cause is identified and dealt with early enough.

Cirrhosis is severe scarring of the liver, leaving it in danger of no longer being able to work properly. This can be serious, causing jaundice, internal bleeding and swelling of the abdomen. Damage caused by cirrhosis is often permanent.

Liver disease: liver cancer

Cirrhosis from long-term infection with hepatitis B and hepatitis C significantly increases the chances of liver cancer developing.
Liver cancer is difficult to treat and surgery, involving the removal of part of the liver or liver transplantation, is often the only option. Small tumours can be removed, but the chance of a new tumour developing within five years is high. Chemotherapy has no proven benefit for survival in liver cancer but can relieve symptoms.

Vaccinations against hepatitis

Vaccinations are available against hepatitis A and hepatitis B. Unless you already have immunity to hepatitis A or B as a result of clearing a previous infection with the virus, you should have these vaccinations. Your HIV clinic can check if you have immunity to one or both, with a blood test.

The chance that the vaccination won’t induce immunity the first time is greater in people with HIV, particularly if you have a low CD4 count, so you might need to repeat the vaccination course. Some clinics may choose to use a double dose of the vaccination against hepatitis B to improve the chances of the vaccine working. As with any other treatment you might receive elsewhere, it’s important that your HIV doctor knows you’re having the vaccinations.

A complete vaccine course can provide long-term protection. You should have annual tests to make sure that your levels of immunity are high enough to protect you. You can have a booster injection if the level isn’t sufficient to protect you.
There is currently no vaccine against hepatitis C.

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