Protect people living with HIV from Hepatitis B

HEALTH

By Annet Nakibuuka

KAMPALA - July 28, is World Hepatitis day. As Uganda joins the rest of the world to commemorate the day set aside by the United Nations to increase awareness about this health issue that is proving stubborn and claiming a number of lives in the world, we ought not to forget that people living with HIV (PLHIV) are a key high risk population that needs our support, in regard to contracting and treatment of Hepatitis B.

A 2007 study on Virology and Clinical Management of Hepatitis B carried out in America (Seattle) indicates that HIV positive people do not respond as well to Hepatitis B vaccination as do the HIV negative ones.

And that the presence of HIV prior to Hepatitis B infection increases the risk of developing chronic hepatitis B, because it lays a safe ground for many opportunistic infections.

This means a lot to mother Uganda, who is struggling with a big HIV prevalence projected at 7.3% as indicated by Uganda AIDS Commission records.

Hepatitis B, just like HIV, is an untreatable viral infection that attacks the liver and can lead to liver cancer.

It is similar to HIV in the way it is transmitted; direct blood contact and sexual activity. Unlike HIV, this one can be prevented particularly through vaccination.

Vaccination is for those who are still negative and can be done in three phases: first dose that provides 50% protection, followed by another after one month and the third dose given six months after the first.

For those found positive, simple oral treatment as recommended by the World Health Organisation (WHO) is given. This first line treatment is either Tenofovir for adults or Entecavir for children.

Special attention must be put on Children Living with HIV. The reason is that as children, most of whom have contracted HIV from their mothers at birth or in the course of breast feeding, their body immunity to Hepatitis B has not fully developed, yet they are already struggling with the Human Immune Virus.

For this reason, if they are not right away protected from acquiring Hepatitis B, their bodies may be too weak to concurrently fight and suppress the two viruses, even when on proper treatment.

To curb Hepatitis B among children, particularly the new-born, experts say vaccinating all expectant mothers who test negative, in addition to prevention of mother-to-child transmission of HIV/AIDS among mothers found positive, are trusted remedies.

Although we are all potential candidates for Hepatitis B, it is a big burden to those already living with HIV as their immunity is presently compromised.

Therefore, adding the pre-conditions of hepatitis B treatment to those of HIV will automatically worsen the situation, and adherence to both is most likely going to fail. Practically, human nature detests medication.

How do you expect them to run the two doses at a go without complaints?

Hepatitis B prevalence in Uganda is at its pick in the northern part of the country, with 4.6% in the districts of Lamwo, Kitgum, Apac, Nwoya, Amuru and those amidst them, followed by those in the far north east which houses Kaabong, Amuria, Amudat, Kotido, Kumi, Serere, Nakapiripirit among others.

The least affected area is south western Uganda with 0.8% in the districts of Ibanda, isingiro, Kabaale, Kisoro, Kanungu and Rubirizi among others. Kampala alone, which receives any one from anywhere is at 1.9%.

Research shows that due to shared modes of transmission, co-infection is common and may speed up progression of the chronic hepatitis B infection.

This means Hepatitis B can be a big challenge to suppress among PLHIV as it requires one to take the medicine daily, yet the very person is already burdened by the daily ARVs. It takes serious commitment, and when you fail on one of them, your health is in utmost danger.

Since there is no specific treatment to severe Hepatitis B, the disease must be prevented among those living with HIV, for many reasons. 

It is known for causing vomiting and diarrhea, both of which may lead to loss of fluids in the body and this is very dangerous for a person living with HIV.

If one is found positive for both HIV and Hepatitis B, they should be ultimately supported so as to reduce risks of failed viral load suppression.

It also reduces the spread of the two viruses, more so to their sexual partners.

Much as there has been varying issues from both government and the citizenry concerning the country's response to the Hepatitis B pandemic, it is the duty of all Ugandans to fight the disease so that it does not partner with HIV/AIDS in hampering our realisation of Vision 2040.

The writer is a Fellow at the National Forum of People Living with HIV Networks in Uganda. anakibuuka@path.org.