The Effect of Concurrent Human Immunodeficiency Virus Infection on Chronic Hepatitis B: A Study of 150 Homosexual Men

Abstract

To determine the influence of concurrent human immunodeficiency virus (HIV) infection on chronic hepatitis B virus (HBV) infection, 150 male homosexual chronic hepatitis B surface antigen (HBsAg) carriers were studied. Of these, 82 subjects (55%) tested positive for antibodies to HIV. They were more likely to express hepatitis B "e" antigen (HBeAg) (P less than .001) and HBV-DNA (P less than .0005) in serum than were HIV-seronegative individuals. However, the degree of immune suppression did not influence HBeAg-HBV-DNA expression. In HBeAg-seropositive subjects, concurrent HIV infection was associated with lower serum alanine transferase levels (P less than .001). This effect increased with the degree of immune suppression as determined by CD4+ lymphocyte counts. Conversely, in patients negative for HBeAg, there was a weak trend towards higher alanine transferase levels with concurrent HIV. This study suggests that chronic hepatitis B may be less severe when accompanied by HIV infection; however, greater viral replication may make it more contagious and resistant to antiviral therapy. These data support an immune-mediated pathogenesis for hepatitis B and have implications for its control.

Chronic hepatitis B

“…[22][23][24][25][26] In addition, immunosuppressed persons are more likely to develop chronic HBV infection after acute infection. 27,28 …”

“…[29][30][31][32][33]43 The rate of clearance of HBeAg is much lower in Asian children (most of whom have normal ALT levels) 34,35 and in immunocompromised subjects. 28,44 The largest prospective follow-up study conducted in Alaska of 1,536 carrier children and adults, followed for 12 years, showed that spontaneous HBeAg clearance occurred in 45% of carriers in 5 years and in 80% after 10 years. 43 Similarly, 3-and 5-year HBeAg clearance rates of 50% and 70% were reported in untreated children with elevated ALT levels from Taiwan and Italy.…”

“…Persons who are chronically coinfected with HBV and HCV may have more rapid progression of liver disease 85 and a higher risk of developing HCC than carriers with HBV infection only. 7 Individuals with HBV and HIV coinfection tend to have higher levels of HBV DNA, lower rates of spontaneous HBeAg seroconversion, 28,44 and more severe liver disease. 86 Hepatitis D virus (HDV) is a satellite virus, which is dependent on HBV for the production of envelope proteins.…”

Prevalence of hepatitis B e antigen among human immunodeficiency virus and hepatitis B virus co-infected patients in Jos, Nigeria

“…A high prevalence of HBeAg in both groups was found; coinfected patients had a significantly higher value than the mono-infected controls. Higher HBeAg prevalence in HIV/HBV co-infected patients than in HBV monoinfected subjects has also been observed in both developed nations and sub-Saharan Africa [4,18,[21][22][23].…”

STUDIES ON HBsAG IN HIV SEROPOSITIVE CASES

“…First, both have a stage of reverse transcription in their replication cycle. Second, destruction of HBV infected hepatocytes with consequent clearance of hepatitis B virus is thought to be mediated by cytotoxic [5]. Because of these mechanisms in patients with past or present infection with HBV, HIV infection can lead to significant alteration in HBV replication, antigen/antibody display and clinical consequences.…”