HIV and viral hepatitis

Clinical description

• Around 8% and 1% of older adults in Malawi may be infected with hepatitis B and C,

respectively.

• Hep B is mostly transmitted during childbirth and in early childhood. Early infection carries a

high risk of liver cirrhosis and cancer later in life.

• Hep B and C can also be transmitted sexually, through blood products and sharing of

contaminated needles.

• HIV and HBV/HCV coinfection accelerates progression to liver disease.
• Hep B and C liver damage increases the risk of ARV drug toxicity.
• Hep B vaccine is currently available as part of the EPI for:

o Infants at age 6, 10 and 14 weeks together with DPT vaccine o All health care workers

• The addition of a Hep B birth dose vaccination (together with BCG and OPV0) is planned. It can

effectively eliminate transmission of Hep B from mother to child.

Routine viral hepatitis screening

• Routinely screen all the following groups with a rapid test for Hepatitis B surface antigen (HBsAg):

o Antenatal women above 20 years at the first visit o STI patients o People starting PrEP o Blood donors o Female sex workers o Prisoners Management of co-infection with HIV and hepatitis B

• HepB HIV co-infected patients are appropriately treated for both with TDF-based ART
• Determine HepB treatment eligibility for all HBsAg positive and HIV negative patients

o About 5% of HBsAg positive people need TDF/3TC lifelong treatment for chronic HepB o Refer to VH clinical guidelines for more information