The effects of HCV coinfection on HIV disease progression are less certain. Some studies have suggested that infection with certain HCV genotypes is associated with more rapid progression to AIDS or death. However, the subject remains Prevention of coinfection with HCV Persons living with HIV who are not already coinfected with HCV can adopt measures to prevent acquiring HCV. Such measures will also reduce the chance of transmitting their HIV infection to others: ● Not injecting or stopping injection drug use would eliminate the chief route of HCV transmission. ● Do not share toothbrushes, razors, and other personal care items that might be contaminated with blood. Although there are no data from the United States indicating that tattooing and body piercing place encouraged to adopt safe behaviors (as described in the previous section) to prevent transmission of HIV and HCV to others. Individuals with evidence of HCV infection should be given information about prevention of liver damage, undergo evaluation for chronic liver disease, and, if indicated, be considered for treatment. Persons coinfected with HIV and HCV should be advised not to drink excessive amounts of alcohol. Avoiding alcohol altogether might be wise because the effects of even moderate or low amounts of alcohol (e.g., 12 ounces of beer, 5 ounces of wine or 1.5 ounces of hard liquor per day) on disease progression are unknown. When appropriate, referral should be made to alcohol treatment and relapse-prevention programs. Because of possible effects on the liver, HCV-infected persons should consult with their health care professional before taking any new medicines, including over the counter, alternative, or herbal medicines. Susceptible coinfected persons should receive a hepatitis A vaccine because the risk for infection with hepatitis A is increased in those with chronic liver disease. Susceptible
controversial. Since coinfected patients are living longer on ART, more data are needed to determine if HCV infection influences the long-term natural history of HIV infection.
persons at increased risk for HCV infection, these procedures may be a source for infection with any bloodborne pathogen if proper infection control practices are not followed. ● Although consistent data are lacking regarding the extent to which sexual activity contributes to HCV transmission, persons having multiple sex partners are at risk for other sexually transmitted diseases (STDs) as well as for transmitting HIV to others. They should be counseled accordingly. patients should receive hepatitis B vaccine because most HIV-infected persons are at risk for HBV infection. The vaccines appear safe for these patients and more than two- thirds of those vaccinated develop antibody responses. Pre- vaccination screening for antibodies against hepatitis A and hepatitis B in this high-prevalence population is generally cost-effective. Post-vaccination testing for hepatitis A is not recommended but testing for antibody to hepatitis B surface antigen (anti-HBs) should be performed one to two months after completion of the primary series of hepatitis B vaccine. Persons who fail to respond should be revaccinated with up to three additional doses. According to the American Association for the Study of Liver Disease (2019): With the availability of HCV directacting antivirals (DAAs), efficacy and adverse event rates among those with HIV/HCV coinfection are similar to those observed with HCV monoinfection. Treatment of HIV/ HCV-coinfected patients, however, requires continued awareness and attention to the complex drug-drug interactions that can occur between DAAs and antiretroviral medications.
How should individuals coinfected with HIV and HCV be managed? General guidelines Persons coinfected with HIV and HCV should be
TUBERCULOSIS
Tuberculosis , also known as TB , is an infectious disease that may affect almost any tissue in the body, especially the lungs. It is caused by the bacteria mycobacterium tuberculosis and characterized by tubercles, the characteristic lesion of tuberculosis. Information from the World Health Organization (2020) notes: ● A total of 1.5 million people died from TB in 2018 (including 251,000 people with HIV). Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS). ● In 2018, an estimated 10 million people fell ill with tuberculosis (TB) worldwide: 5.7 million men; 3.2 million women; and 1.1 million children. There were cases in all countries and age groups. But TB is curable and preventable. Increases in the incidence of TB are related to the high risk among immunosuppressed persons, particularly those infected with HIV. Drug-resistant strains of this deadly disease have contributed to the problem. Outbreaks have occurred in hospitals, correctional institutions, homeless shelters, nursing homes, and residential care facilities for AIDS patients.
TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they move through the blood to other parts of the body, such as the kidney, spine, and brain. TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious. People with TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called TB infection .
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