hepatitis A (HAV)

What is hepatitis A and how is it transmitted ?

Hepatitis A is caused by the hepatitis A virus (HAV). HAV is spread through food / drink contaminated with fecal matter (stool) of an infected person enter another person's mouth. HAV is mainly transmitted through raw or inadequately cooked, handled or prepared by someone withhepatitis A (although maybe he did not know he was infected).

Drinking water or ice that is contaminated with feces is another source of infection, as well as shellfish that are not cooked enough. HAV can be transmitted through "rimming" (oral-anal sex, or between the mouth and anus). HAV is rarely transmitted through blood-to-blood.

Hepatitis A is an acute form of hepatitis, meaning do not cause chronic infection. Once we've had hepatitis A, we can not be infected again. However, we can still be infected with other hepatitis viruses.

What are the symptoms of hepatitis A?

Not all people infected with HAV will have symptoms. For example, many infants and young children infected with HAV do not experience any symptoms. Symptoms are more likely to occur in older children, adolescents and adults.

Symptoms of hepatitis A (acute hepatitis and in general) can including :

• skin and whites of the eyes become yellow (jaundice)
• Fatigue
• right-upper abdominal pain
• Loss of appetite
• Weight loss
• Fever
• Nausea
• Diarrhoea or diarrhe
• Vomiting
• Water arts such as tea and / or dirt-colored putty
• joint pain

HAV infection can also increase the levels of enzymes made by the liver to be above normal in the blood. The immune system require up to eight weeks to remove the HAV from the body. If symptoms develop, generally within two to four weeks after infection. Symptoms ofhepatitis A is generally only one week, but can be more than a month. Approximately 15 percent of people with hepatitis A have symptoms from six to nine months. Approximately one in 100 people infected with HAV may experience rapid and severe infections (so-called 'fulminant'), which - very rarely - can lead to liver failure and death.

How is hepatitis A diagnosed ?

Diagnosis of hepatitis A is confirmed by blood tests. The doctor will order these tests if we are experiencing symptoms of hepatitis A or if we want to know whether you were infected with HAV in the past. The blood test looks for two types of antibodies to the virus, which referred to as IgM and IgG (Ig stands for immunoglobulin). First, look for IgM antibodies, produced by the immune system of five to ten days before symptoms appear and usually disappear within six months. Tests also search for IgG antibodies, IgM antibodies are replaced and protect against HAV infection.

• When blood tests show negative for IgM antibodies and IgG, we probably have never been infected with HAV, and should consider getting vaccinated against HAV.
• If you are positive for IgM antibodies and negative to IgG, our chances of contracting HAV in six past month, and the immune system is being removing a virus or infection is becoming increasingly severe.
• When the tests showed negative for IgM antibodies and positive for IgG antibodies, we may be infected with HAV in an earlier time, or we already vaccinated against HAV. We are now immune to HAV.

Note : Hepatitis A is endemic in Indonesia. This means that the majority of Indonesian people ever exposed to HAV during childhood, and most likely will be immune to infection again. Because of this, most doctors HAV test is not considered beneficial for people with HIV in

Indonesia.

How to people with HIV ?

People with HIV do not have the risk of becoming infected with HAV higher

than others. However, several studies indicate that people with HIV is more likely to experience symptoms of hepatitis A for Longer term, the meaning may take longer to recover fully from hepatitis A. One other important issue to consider is that many HIV-positive people taking antiretroviral drugs can be bad for the liver. Some of these drugs can worsen the symptoms ofhepatitis A. Because of this, maybe we should stop using all drugs so that the hepatitis A began to recover or liver enzyme levels returned to normal. Talk with your doctor before any medication dismiss.

How is hepatitis A treated ?

The usual treatment for hepatitis A is a break at sleep. There are also important to drink plenty of fluids, especially when we experiencing diarrhea or vomiting. Painkillers which counter, such as ibuprofen can reduce the symptoms hepatitis A, but we should talk more check with your doctor.

When we feel we may have been exposed to HAV - for example when someone in our household recently been diagnosed with hepatitis A - we should see a doctor to discuss the benefits of immune globulin injection (also called as gamma globulin). Immune globulin contains lots of antibodies against HAV, which can help prevent the onset of disease when we are exposed to the virus. Immune globulin must be given within two to six weeks after we might have been exposed to HAV. When we receive immune globulin to preventhepatitis A, we should also receive hepatitis A vaccine (discussed below).

How can hepatitis A be prevented ?

The best way to prevent hepatitis A is vaccination. Vaccination requires two injections, usually given with a time gap of six months. Side effects of hepatitis A vaccination, if it occurs, is usually mild and may include soreness at the injection site and mild flu-like symptoms. Also available is a combination vaccine for viralhepatitis A and B. HAV vaccine is very effective - more than 99 percent of people who receive a vaccination immune to viruses and not be exposed tohepatitis A if exposed. There is little doubt that HAV vaccination in people with very low CD4 counts may not provide immunity (due to very weak immune systems), so it should be vaccinated at a CD4 count is still quite high.

When we feel we have not been infected with hepatitis A, we should discuss with your doctor. Because people with HIV often experience more severe symptoms when infected with HAV, and our heart is essential to remove the remaining end of ARV drugs, HAV vaccination is recommended for people with HIV. Vaccination is especially important for people with HIV and hepatitis B or C.

Although we have not received vaccination against hepatitis A, there are some things we can do to prevent

HAV infection:

• Avoid water, including ice, which could be contaminated with feces
• Avoid raw shellfish or undercooked
• Always wash hands with soap and water after using the room
• bathing, changing diapers and before preparing
• or eating food
• Wearing a latex barrier ('dental dam') to sex oralanal