Editing Hepatitis (section)

== Special populations ==

=== HIV co-infection ===
Persons infected with HIV have a particularly high burden of [[Hepatitis C and HIV coinfection|HIV-HCV co-infection]].<ref name="HIV co-infection">{{Cite journal|last1=Jordan|first1=Ashly E.|last2=Perlman|first2=David C.|last3=Neurer|first3=Joshua|last4=Smith|first4=Daniel J.|last5=Des Jarlais|first5=Don C.|last6=Hagan|first6=Holly|date=2016-01-28|title=Prevalence of hepatitis C virus infection among HIV+ men who have sex with men: a systematic review and meta-analysis|journal=International Journal of STD & AIDS|volume=28|issue=2|pages=145–159|doi=10.1177/0956462416630910|issn=1758-1052|pmid=26826159|pmc=4965334}}</ref><ref name="Platt, Easterbrook et al">{{Cite journal|last1=Platt|first1=Lucy|last2=Easterbrook|first2=Philippa|last3=Gower|first3=Erin|last4=McDonald|first4=Bethan|last5=Sabin|first5=Keith|last6=McGowan|first6=Catherine|last7=Yanny|first7=Irini|last8=Razavi|first8=Homie|last9=Vickerman|first9=Peter|date=2016-02-24|title=Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis|journal=The Lancet. Infectious Diseases|doi=10.1016/S1473-3099(15)00485-5|issn=1474-4457|pmid=26922272|volume=16|issue=7|pages=797–808|url=http://researchonline.lshtm.ac.uk/2532806/1/PLATT%20Lancet%20Inf%20Dis%20250116%20final%20accepted.pdf |archive-url=https://web.archive.org/web/20180719062234/http://researchonline.lshtm.ac.uk/2532806/1/PLATT%20Lancet%20Inf%20Dis%20250116%20final%20accepted.pdf |archive-date=2018-07-19 |url-status=live}}</ref>  In a recent study by the [[World Health Organization|WHO]], the likelihood of being infected with hepatitis C virus was six times greater in those who also had HIV.<ref name="Platt, Easterbrook et al" />  The prevalence of HIV-HCV co-infection worldwide was estimated to be 6.2% representing more than 2.2 million people.<ref name="Platt, Easterbrook et al" />  Intravenous drug use was an independent risk factor for HCV infection.<ref name="Rosen - Clinical Practice" /> In the WHO study, the prevalence of HIV-HCV co-infection was markedly higher at 82.4% in those who injected drugs compared to the general population (2.4%).<ref name="Platt, Easterbrook et al" /> In a study of HIV-HCV co-infection among HIV positive men who have sex with men (MSM), the overall prevalence of anti-hepatitis C antibodies was estimated to be 8.1% and increased to 40% among HIV positive MSM who also injected drugs.<ref name="HIV co-infection" />

=== Pregnancy ===

==== Hepatitis B ====
[[Vertically transmitted infection|Vertical transmission]] is a significant contributor of new [[hepatitis B virus|HBV]] cases each year, with 35–50% of transmission from mother to neonate in endemic countries.<ref name="ACOG Practice Bulletin" /><ref name="mother-to-neonate">{{Cite book|title="Hepatic, Biliary, and Pancreatic Disorders." Williams Obstetrics, Twenty-Fourth Edition|last=Cunningham|first=F. Gary|publisher=McGraw-Hill|year=2013|location=New York, NY|display-authors=etal}}</ref> Vertical transmission occurs largely via a neonate's exposure to maternal blood and vaginal secretions during birth.<ref name="mother-to-neonate" /> While the risk of progression to chronic infection is approximately 5% among adults who contract the virus, it is as high as 95% among neonates subject to vertical transmission.<ref name="ACOG Practice Bulletin" /><ref>{{Cite journal|last=Tassopoulos|first=NC|display-authors=etal|date=June 1987|title=Natural history of acute hepatitis B surface antigen-positive hepatitis in Greek adults.|journal=Gastroenterology|volume=92|issue=6|pages=1844–50|doi=10.1016/0016-5085(87)90614-7|pmid=3569758}}<!--|access-date=March 16, 2016--></ref> The risk of viral transmission is approximately 10–20% when maternal blood is positive for HBsAg, and up to 90% when also positive for [[HBeAg]].<ref name="ACOG Practice Bulletin" />

Given the high risk of perinatal transmission, the [[Centre for Disease Control|CDC]] recommends screening all pregnant women for HBV at their first prenatal visit.<ref name="ACOG Practice Bulletin" /><ref>{{Cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm?s_cid=rr5416a1_e|title=A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part 1: Immunization of Infants, Children, and Adolescents|website=www.cdc.gov|access-date=2016-03-16|url-status=live|archive-url=https://web.archive.org/web/20160324191034/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm?s_cid=rr5416a1_e|archive-date=2016-03-24}}</ref> It is safe for non-immune pregnant women to receive the HBV vaccine.<ref name="ACOG Practice Bulletin" /><ref name="mother-to-neonate" /> Based on the limited available evidence, the [[American Association for the Study of Liver Diseases]] (AASLD) recommends antiviral therapy in pregnant women whose viral load exceeds 200,000 IU/mL.<ref name="AASLD guidelines for chronic B">{{Cite journal|last1=Terrault|first1=Norah A.|last2=Bzowej|first2=Natalie H.|last3=Chang|first3=Kyong-Mi|last4=Hwang|first4=Jessica P.|last5=Jonas|first5=Maureen M.|last6=Murad|first6=M. Hassan|date=2016-01-01|title=AASLD guidelines for treatment of chronic hepatitis B|journal=Hepatology|volume=63|issue=1|pages=261–283|doi=10.1002/hep.28156|issn=1527-3350|pmid=26566064|pmc=5987259}}</ref> A growing body of evidence shows that antiviral therapy initiated in the third trimester significantly reduces transmission to the neonate.<ref name="mother-to-neonate" /><ref name="AASLD guidelines for chronic B" /> A systematic review of the Antiretroviral Pregnancy Registry database found that there was no increased risk of congenital anomalies with [[Tenofovir disoproxil|Tenofovir]]; for this reason, along with its potency and low risk of resistance, the AASLD recommends this drug.<ref name="AASLD guidelines for chronic B" /><ref>{{Cite journal|last1=Wang|first1=Liming|last2=Kourtis|first2=Athena P.|last3=Ellington|first3=Sascha|last4=Legardy-Williams|first4=Jennifer|last5=Bulterys|first5=Marc|date=2013-12-01|title=Safety of tenofovir during pregnancy for the mother and fetus: a systematic review|journal=Clinical Infectious Diseases|volume=57|issue=12|pages=1773–1781|doi=10.1093/cid/cit601|issn=1537-6591|pmid=24046310|doi-access=free}}</ref> A 2010 systematic review and meta-analysis found that [[Lamivudine]] initiated early in the third trimester also significantly reduced mother-to-child transmission of HBV, without any known adverse effects.<ref>{{Cite journal|last1=Shi|first1=Zhongjie|last2=Yang|first2=Yuebo|last3=Ma|first3=Lin|last4=Li|first4=Xiaomao|last5=Schreiber|first5=Ann|date=2010-07-01|title=Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis|journal=Obstetrics and Gynecology|volume=116|issue=1|pages=147–159|doi=10.1097/AOG.0b013e3181e45951|issn=1873-233X|pmid=20567182|s2cid=41784922}}</ref>

The [[American Congress of Obstetricians and Gynecologists|ACOG]] states that the evidence available does not suggest any particular mode of delivery (i.e. [[Vaginal delivery|vaginal]] vs. [[Caesarean section|cesarean]]) is better at reducing vertical transmission in mothers with HBV.<ref name="ACOG Practice Bulletin" />

The [[World Health Organization|WHO]] and CDC recommend that neonates born to mothers with HBV should receive hepatitis B immune globulin ([[Hepatitis B immune globulin|HBIG]]) as well as the [[Hepatitis B vaccine|HBV vaccine]] within 12 hours of birth.<ref name="CDC recommendations for Hepatitis B" /><ref name="WHO guidelines for chronic Hepatitis B" /> For infants who have received HBIG and the HBV vaccine, breastfeeding is safe.<ref name="ACOG Practice Bulletin" /><ref name="mother-to-neonate" />

==== Hepatitis C ====
Estimates of the rate of [[hepatitis C virus|HCV]] vertical transmission range from 2–8%; a 2014 systematic review and meta-analysis found the risk to be 5.8% in HCV-positive, HIV-negative women.<ref name="ACOG Practice Bulletin" /><ref name="Benova - vertical transmission">{{cite journal |last1=Benova |first1=Lenka |last2=Mohamoud |first2=Yousra A. |last3=Calvert |first3=Clara |last4=Abu-Raddad |first4=Laith J. |date=2014-09-15 |title=Vertical transmission of hepatitis C virus: systematic review and meta-analysis |journal=Clinical Infectious Diseases |volume=59 |issue=6 |pages=765–773 |doi=10.1093/cid/ciu447 |issn=1537-6591 |pmc=4144266 |pmid=24928290}}</ref> The same study found the risk of vertical transmission to be 10.8% in HCV-positive, HIV-positive women.<ref name="Benova - vertical transmission" /> Other studies have found the risk of vertical transmission to be as high as 44% among HIV-positive women.<ref name="ACOG Practice Bulletin" /> The risk of vertical transmission is higher when the virus is detectable in the mother's blood.<ref name="Benova - vertical transmission" />

Evidence does not indicate that mode of delivery (i.e. vaginal vs. cesarean) has an effect on vertical transmission.<ref name="ACOG Practice Bulletin" />

For women who are HCV-positive and HIV-negative, breastfeeding is safe. CDC guidelines suggest avoiding it if a woman's nipples are cracked or bleeding to reduce the risk of transmission.<ref name="ACOG Practice Bulletin" /><ref name="CDC - HCV prevention">{{cite journal |date=October 16, 1998 |title=Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00055154.htm |journal=MMWR |pmid=9790221 |access-date=March 16, 2016 |volume=47 |issue=RR-19 |pages=1–39 |url-status=live |archive-url=https://web.archive.org/web/20160324082023/http://www.cdc.gov/mmwr/preview/mmwrhtml/00055154.htm |archive-date=March 24, 2016 }}</ref>

==== Hepatitis E ====
Pregnant women who contract [[Hepatitis E virus|HEV]] are at significant risk of developing fulminant hepatitis with maternal mortality rates as high as 20–30%, most commonly in the third trimester .<ref name="Harrison's Principles, chapter 360 (Acute Viral)" /><ref name="ACOG Practice Bulletin" /><ref name="mother-to-neonate" /> A 2016 systematic review and meta-analysis of 47 studies that included 3968 people found maternal [[Case fatality rate|case-fatality rates]] (CFR) of 20.8% and fetal CFR of 34.2%; among women who developed fulminant hepatic failure, CFR was 61.2%.<ref>{{Cite journal|last1=Jin|first1=H.|last2=Zhao|first2=Y.|last3=Zhang|first3=X.|last4=Wang|first4=B.|last5=Liu|first5=P.|date=2016-03-01|title=Case-fatality risk of pregnant women with acute viral hepatitis type E: a systematic review and meta-analysis|journal=Epidemiology & Infection|volume=FirstView|issue=10|pages=2098–2106|doi=10.1017/S0950268816000418|pmid=26939626|pmc=9150575 |issn=1469-4409|doi-access=free}}</ref>