Hepatitis B and human immunodeficiency virus coinfection

Abstract

Coinfection with human immunodeficiency virus-1 (HIV) and hepatitis B virus (HBV) is common; worldwide, an estimated 10% of HIV-infected persons have chronic hepatitis B. Because the incidence of traditional acquired immunodeficiency syndrome-related opportunistic infections has decreased with successful anti-HIV therapy, liver disease has emerged as a leading cause of morbidity and mortality in HIV-infected individuals. HIV infection negatively impacts all phases of the natural history of hepatitis B leading to increased rates of persistent infection, higher HBV DNA levels, lower rates of hepatitis B e antigen loss, increased cirrhosis and liver-related mortality, and increased risk of hepatocellular carcinoma at lower CD4؉ T cell counts. The management of hepatitis B in HIV infection is complicated by the dual activity of several nucleoside analogs, the more rapid development of lamivudine-resistant HBV in patients who are HIV-positive, and the paucity of studies in this population. Until further research emerges on the optimal treatment for this population, data from HBV monoinfected persons will need to be extrapolated to the HIV-HBV coinfected population. Further research is also needed to determine the mechanism(s) for the increased liver disease progression and optimal treatment goals. (HEPATOLOGY 2009;49: S138-S145.)

Effect of Hepatitis B Virus Co-Infection on CD4 Cell Count and Liver Function of HIV Infected Patients

“…This difference was much more significant among the co-infected patients and therefore confirms previous studies that suggested that HIV infection accelerated the progression to hepatic complications in HBV infected men. 5,6 Routine estimation of Alanine aminotransferase (ALT) is an inexpensive and non-invasive means of assessing liver disease as it reflects the activity of hepatotropic viruses and status of liver during therapy with various hepatotoxic drugs. Even though it is well known that ALT may even be normal in the presence of advanced liver disease, in resource limited countries like Nigeria it still remains the affordable test in the assessment of liver function in the management of HIV/AIDS patients.…”

“…The progression of hepatic complications from HBV infection is accelerated in patients co-infected with HIV. 5,6 This is particularly so in HIV infected men with very low CD4 count. 7 In addition, HIV infected individuals are more likely to lose previously developed protective anti-HBs antibody and develop acute hepatitis B infection; this risk is also associated with lower CD4 counts.…”

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…The rate of hepatitis B clearance is also lower, with up to 20-40% of infected patients progressing to chronic (46 months) infection [82,83]. Progression to liver cancer is more rapid, with HIV-positive patients with HBV infection developing liver cancer younger than patients with HBV infection alone [52,[82][83][84].…”

Seasonal variation of hepatitis B and C virus infection among HIV- and non-HIV-infected patients in Benin City, Nigeria

“…Sub-Saharan Africa is reported to have the highest burden of HBV and HCV infection in the world [1,2]. As a result of shared routes of transmission, co-infection of HCV and HBV is common among human immunodeficiency virus (HIV)-infected patients [3,4]. Nigeria is Africa's most populous nation, and is home to more people living with HIV than any other country in the world, except South Africa and India [5].…”