A presentation by Tonia Poteat from the CDC Global AIDS Project on the topic of Hepatitis B & C and HIV Co-infection. This webcast was presented live to ECHO (Evaluation Center for HIV and Oral Health) grantees on June 5, 2008.

1. Tonia Poteat, MMSc, PA-C Thursday, June 5, 2008 ECHO Webinar HIV and Viral Hepatitis In Oral Health Settings

3. HIV

5. Periodontal Disease in HIV Disease

6. Oral Candidiasis (Thrush)

7. Oral Hairy Leukoplakia

9. Credit: I-TECH

10. Bleeding gums http://www.perio.org/consumer/children.htm

13. Comparison of Viral Hepatitides

14. HEPATITIS A

16. Jaundice http://www.gideononline.com/blog/2007/05/01/easier-diagnosis-with-symptom-images/

18. HIV and Chronic Viral Hepatitis HIV HCV HBV 30% DNA 6,000 1.25 million 4 million 1 million US Prevalence 3% 0.3% Percutaneous Transmission Risk RNA RNA Genetic Material 10,000 16,000 Annual US Deaths

19. HEPATITIS B

24. HBV Treatment Options in HIV www.medscape.com TDF/FTC coformula 3TC equivalent Low Middle Yes Emtricitabine* (Emtriva) Good for 3TC and adefovir failures High High Yes Tenofovir* (Viread) No studies in HIV Middle? High No Telbivudine (Tyzeka) Ok for 3TC failures Tolerable High High YES! Entecavir (Baraclude) Good for ESLD and 3TC failures Middle Middle No Adefovir (Hepsera) High tolerability Low Middle Yes Lamivudine (Epivir HB) Tx x 12 mo No use in ESLD No High Yes Peg-IFN Notes Resistance barrier HBV potency HIV Activity? Drug

27. HEPATITIS C

28. Risk factors for Hepatitis C infection 20% 10% 5% 55% 10% IVDU Cocaine Exposure to infected sex partner or multiple partners Occupational, hemodialysis, household, perinatal No recognized source http://www.cdc.gov/ncidod/diseases/hepatitis/c_training/edu/transmission modes; 2000

31. Natural History of Hepatitis C Virus (HCV) Infection Exposure (Acute phase) Resolved Chronic Cirrhosis Stable Slowly Progressive HCC Transplant Death 20% (17) 15% (15) 85% (85) 25% (4) 80% (68) 75% (13) HIV and Alcohol HCC = hepatocellular carcinoma. Alter MJ. Semin Liver Dis . 1995;15:5-14. NIH Consensus Statement. Management of hepatitis C. National Institutes of Health; March 24-26, 1997.

41. PEP

42. Hepatitis B MMWR, June 29, 2001

45. HIV: Mucus Membrane Exposure MMWR, Sept 30, 2005

46. HIV: Needlestick Exposure MMWR, Sept 30, 2005