especially for patients who co-infected with HIV and HCV.

Other than trying to prevent it through vaccination, there is no standard therapy for HBV at this time. Studies have shown that interferon alfa-2b is effective at treating HBV in about 40% of cases in the general population and is even less effective in patients with HIV. Interferon is applied subcutaneously (under the skin) or into the muscle 3 times a week for 4 months or longer, and many patients experience side effects. Studies have shown that lamivudine (3TC, Epivir), famcyclovir, and adefovir dipovoxil may help reduce HBV levels in the blood and restore liver function.

Patients who have chronic HBV should visit a health care provider regularly. All patients with HIV should be tested for hepatitis B infection and should receive the hepatitis B vaccine if they have not been exposed to the virus.

Hepatitis C (HCV) is a very serious, potentially life-threatening infection. HCV is transmitted through sexual contact, through contact with blood from an infected person, by sharing needles, and from mother to infant. The initial symptoms of HCV are very similar to those for other viral hepatitis infections, although they tend to be milder. They include fever, fatigue, muscle and joint pain, nausea and vomiting, and jaundice. Only about 25% of patients who are infected with HCV show initial symptoms. Yet, HCV is a much more serious disease than either HAV or HBV, especially for patients who co-infected with HIV and HCV.

Hepatitis C occurs in approximately 1.8% of the general population and has been reported to occur in 12-90% of patients with HIV. People who are exposed to HIV through injecting drugs are much more likely to contract the disease. The progression of hepatitis C to cirrhosis is more rapid in HIV-infected patients who drink alcohol. Patients with HCV should avoid drinking alcohol.

Active hepatitis B or HAV infection speeds the progression to cirrhosis in patients with hepatitis C. Patients with hepatitis C should be vaccinated against hepatitis A and B, if they have not already been exposed to it.

Like HBV, HCV can become chronic. Indeed, most HCV cases are chronic. It is estimated that as many as 85% of patients who are infected with HCV develop a chronic infection, and as many as 70% of patients with HCV develop some type of chronic liver disease. Patients with HIV develop serious liver problems more quickly than people who are not infected with HIV and are more likely to die from sudden liver failure.

Unlike HAV and HBV, there is no vaccine against HCV. To prevent transmission, people should practice safer sex and should not share drug injection equipment. Like HIV, HCV evolves and develops resistance very quickly, making treatment a difficult challenge. Most physicians prescribe a combination of drugs, which may include one or more types of interferons coupled with ribavirin.

Several studies are being done in an effort to find a better treatment for HCV. All patients who are chronically infected with HCV should visit their doctor or other health care professional regularly.

Shingles

Shingles is a very painful skin rash that is caused by the same herpesvirus that causes chickenpox (varicella zoster). Like other herpesviruses, there is an initial infectious stage, followed by a dormant stage, and then, the virus may become active again, sometimes decades later. The initial infectious stage manifests as the chickenpox, and the later flare-up is shingles. Only people who have had chickenpox or the chickenpox vaccine can develop shingles.

Patients with HIV are much more likely to develop shingles than people who are not infected with HIV. Shingles is often an early sign of immune deficiency, but it can occur at any time, and at any T-cell count, even after starting antiretroviral therapy

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A shingles outbreak typically starts as very painful belt-like rash on one side of the body, usually on the chest, back, forehead, or in the eye. A couple of days later, another rash usually appears on the skin area where the infected nerve is inflamed (herpes zoster lives in nerve tissue). The rash is made up of small blisters that crust over.

The virus can be transmitted if the blisters break open. This does not mean that shingles is transmitted; rather, people who have never had chickenpox or the chickenpox vaccine could catch the chickenpox.

Rarely, shingles can spread to internal organs and cause serious complications. In most cases, it goes away within a couple of weeks. Some patients develop a painful, chronic condition called postherpetic neuralgia that may last months or even years.

Patients who have shingles should see a physician or other health care provider. Shingles and postherpetic neuralgia can be treated successfully. The same medications that are used to treat oral herpes and genital herpes can be used to treat shingles, including famciclovir, valacyclovir, and acyclovir.

The drugs are generally prescribed in larger doses for shingles and they should be started as early as possible so as to shorten the course of infection and prevent development of postherpetic neuralgia. Low doses of some antidepressants (e.g., amitryptaline) or antiseizure medications (e.g., carbamazepam, gabapentin) also may be used to prevent or treat postherpetic neuralgia.

Anyone with shingles near the eye should see a health care provider immediately to prevent permanent eye damage. For additional information on shingles or postherpatic neurolgia, go to dermatologychannel.net.