Lesson 2: Secondary Prevention of Viral Hepatitis Core Competency 2: Primary and Secondary Prevention of HCV among PLWH Lesson 2: Secondary Prevention of Viral Hepatitis PLWH = People Living with HIV July 2017

Authors and Funders This presentation was prepared by Leigh Guarinello, MPH, (MidAtlantic AETC) and John Nelson, PhD, CPNP, (AETC National Coordinating Resource Center) for the AETC National Coordinating Resource Center in July 2017. This presentation is part of a curriculum developed by the AETC Program for the project: Jurisdictional Approach to Curing Hepatitis C among HIV/HCV Co-infected People of Color (HRSA 16-189), funded by the Secretary's Minority AIDS Initiative through the Health Resources and Services Administration HIV/AIDS Bureau.

Lesson Objective Identify secondary prevention interventions for people with HCV infection

HAV and HBV Screening Evaluation for other conditions that affect the liver, including HAV and HBV1 HAV IgM anti-HAV2, IgG anti-HAV Indicates past infection or vaccine-related immunity (IgG), acute infection (IgM), susceptibility3 HBV HBsAg, anti-HBs, anti-HBc, IgM anti-HBc Indicates resolved infection, acute infection, chronic infection, vaccine-related immunity, susceptibility4,5 Evaluate for other liver infections. Determine susceptibility to other liver infections. HAV (fecal to oral): generally determining between immunity (past infection) and susceptibility (no past infection or vaccine). Acute infection is short. HBV (bloodborne, sexually transmitted): several scenarios that can indicate immunity, infection, or susceptibility. If person is actively infected with HBV, assess for treatment need.

HAV and HBV Vaccination Recommended for all susceptible persons with HIV/HCV co-infection1 HAV/HBV combination vaccines: 3-4 doses HAV: 2 doses6 HBV: 2-3 doses IM Post-vaccination testing for serologic response 1-2 months after last dose7 Vaccination against other viral hepatitides. If susceptible to both viruses, consider a combination vaccine and choose the appropriate schedule. Because of HIV infection, serologic testing after 1-2 months to assess whether immunity was acquired.

Risk Reduction for HAV Vaccination Precautions when traveling in endemic regions Bottled or boiled water (including for brushing teeth), peel and wash fruit and vegetables, avoid undercooked meat and fish Good hygiene Washing hands often -- diaper changes, preparing food, eating8 Barrier methods during anilingus9 HAV is the result of fecal to oral transmission. Best prevention is vaccination. If not immune, be aware (in particular in endemic regions) when: Eating Drinking Hygiene (including tooth brushing) Mouth to anus sexual activity

Risk Reduction for HBV Vaccination Partner testing and disclosure Use of condoms Safe use of injection equipment Precautions with piercing and tattooing Precautions when traveling to endemic regions10 HBV is the result of sexual and blood borne exposures. Best prevention is vaccination. Serodiscordant couples should avoid sharing injection equipment or having unprotected sex. Beware of anything pointy used to break the skin.

Harm Reduction for Liver Disease Alcohol abstinence Clinician or pharmacist review of all medications, including: Prescription, over the counter, supplements, herbals, hormones11 Safe food practices Healthy behaviors Diet and exercise for a healthy weight Control blood sugar, cholesterol, blood fats Reduce stress, increase emotional support12 Potential pre-existing challenges for HIV/HCV co-infected: Existing liver damage due to HCV Inflammation due to HIV Liver affects of medications Be kind to your liver – it doesn’t complain. Avoid behaviors that challenge the liver further: Drinking alcohol taking certain medications Eating/preparing food without proper precautions and appropriate cooking Engage in behaviors that maintain health Eat healthy Exercise Appropriately manage other indicators of health Seek emotional balance, reduce stress, engage

Disclaimer and Permissions Users are cautioned that because of the rapidly changing medical field, information could become out of date quickly. You may use or present this slide set and other material in its entirely or incorporate into another presentation if you credit the author and/or source of the materials. The complete HIV/HCV Co-infection: An AETC National Curriculum is available at: https://aidsetc.org/hivhcv

Lesson 2.3: Treatment as Prevention Continue to next lesson Lesson 2.3: Treatment as Prevention