HIV and viral hepatitis coinfections: advances and challenges

Abstract

With a prevalence affecting over 30% of HIV infected patients, coinfection with hepatitis B (HBV) or C (HCV) virus remains one of the most frequent comorbidities in this population, with a significant impact in terms of morbidity and mortality associated with liver disease. Recent findings in the physiopathology of HIV in the liver have confirmed that it may contribute, along with hepatotoxicity of antiretrovirals and the burden of metabolic diseases, to a more rapid progression of liver fibrosis, especially when there is underlying chronic hepatitis coinfection. Both fields of research and clinical appraisal of HBV and HCV coinfection are rapidly evolving and prompt a change in the former paradigms of clinical care and management of chronic hepatic coinfection in the context of HIV. The advent of anti-HCV direct antiviral agents has indeed completely shaken up the treatment guidelines for HCV, and the tricky management of these new agents with antiretrovirals means referring patients to specialised centres. In HBV coinfection, therapeutic options have not changed recently but new challenges have emerged regarding the management of low replicating HBV-DNA in optimally treated patients and long term exposure to antivirals. Finally, the global increase in life expectancy in HIV infected patients has been accompanied in coinfected patients by a higher risk of emergence of end stage liver diseases for which access to orthotopic liver transplantation and innovative procedures such as targeted hepatocellular carcinoma therapies should be facilitated.

Prevalence and Determinants of Cryptosporidium Infection in an Underdeveloped Rural Region of Southwestern China

“…37 Conversely, existing evidence points out that HBV and HCV coinfections are associated with worse outcomes for HIV-positive patients. [37][38][39] In addition, HBV/HCV coinfection may accelerate liver disease progression and increase the risk of hepatocellular carcinoma. 40 Thus the question of whether the interplay among HIV, HBV, and HCV infections influences Cryptosporidium infection is important.…”

Management of Chronic Hepatitis B in Patients from Special Populations

“…Finally, if only HIV infection is required to be treated and treatment for HBV is not necessarily required, two drugs active against HBV in a fully potent HARRT regimen, for example, tenofovir with lamivudine or with emtricitabine should be considered (Mendes-Corrêa and Nú -ñez 2010; Lacombe and Rockstroh 2012). This is to prevent the risk of HBV viral reactivation caused by immune reconstitution syndrome secondary from the successful HIV treatment.…”

Profile of HIV subtypes in HIV/HBV- and HIV/HCV-coinfected patients in Southern Brazil

“…It has been estimated that 30% of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA) are coinfected with hepatitis C virus (HCV) or hepatitis B virus (HBV) 1 However, the prevalence of these coinfections is variable, reflecting differences in the regional sociodemographic profile and hepatitis B immunization coverage 2 . In Brazil, the prevalence of HIV/HCV coinfection ranged from 3.3% to 82.4%, with an average of around 20.3% 3 .…”