8.1 Prevention, screening and management of common coinfections
Consolidated ARV guidelines, June 2013
8.1.4 Hepatitis B and C
Chronic hepatitis B virus infection affects 5–20% of the 33 million people living with HIV worldwide, and hepatitis C affects 5–15%, although this may be up to 90% among people who inject drugs (9,10). The burden of coinfection is greatest in low- and middle-income countries, particularly in South-East Asia and sub-Saharan Africa for hepatitis B. Viral hepatitis is an increasing cause of morbidity and mortality among people living with HIV, including those on ART. A comprehensive approach includes prevention, hepatitis B and hepatitis C screening, hepatitis B vaccination and treatment and care for people with HIV coinfected with hepatitis B and/or hepatitis C.
Guidance on timing of ART in hepatitis B and C
- Hepatitis B: when to start and what to start. See sections 7.1.1 (When to start ART in adults and adolescents), and 7.2.1.
- Hepatitis C: when to start and what to start. Initiating ART among people with HIV and hepatitis C should follow the same general principles as for the general population of people living with HIV (section 7.1: When to start ART).
The WHO guidelines for the management of hepatitis C are scheduled to be published in 2014. They will provide detailed guidance on hepatitis C screening, hepatitis C–specific treatment and general hepatitis C care.