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| {{Hepatitis B}} | | __NOTOC__ |
| {{CMG}}; {{AOEIC}} [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
| | {{HIV coinfection with hepatitis b}} |
| ==Overview==
| | '''For main chapter on AIDS, click [[AIDS|here]]''' |
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| Co infection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) is common due to shared routes of transmission. The impact of co infection is especially important in regions with widespread use of ART.<ref name="pmid17521593">{{cite journal |author=Hoffmann CJ, Thio CL |title=Clinical implications of HIV and hepatitis B co-infection in Asia and Africa |journal=Lancet Infect Dis |volume=7 |issue=6 |pages=402–9 |year=2007 |month=June |pmid=17521593 |doi=10.1016/S1473-3099(07)70135-4 |url=http://linkinghub.elsevier.com/retrieve/pii/S1473-3099(07)70135-4 |accessdate=2012-03-29}}</ref> As the use of ART becomes more prevalent in parts of the world with high HBV endemicity and long term survival increases, it is likely that liver disease from chronic hepatitis B in HIV-infected population may emerge as a greater public health problem than before.<ref name="pmid17521593">{{cite journal |author=Hoffmann CJ, Thio CL |title=Clinical implications of HIV and hepatitis B co-infection in Asia and Africa |journal=Lancet Infect Dis |volume=7 |issue=6 |pages=402–9 |year=2007 |month=June |pmid=17521593 |doi=10.1016/S1473-3099(07)70135-4 |url=http://linkinghub.elsevier.com/retrieve/pii/S1473-3099(07)70135-4 |accessdate=2012-03-29}}</ref>
| | '''For main chapter on HIV, click [[HIV|here]]''' |
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| | '''For main chapter on Hepatitis B, click [[Hepatitis B|here]]''' |
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| ==Epidemiology==
| | {{CMG}}; {{AOEIC}} [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org] |
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| In areas of low endemicity, such as North America, Australia and Europe, HBV and HIV infection are usually acquired in adulthood through sexual or percutaneous transmission. In areas of low endemicity, the prevalence of chronic co infection is around 5-7% among HIV-infected individuals.<ref name="pmid16352363">{{cite journal |author=Alter MJ |title=Epidemiology of viral hepatitis and HIV co-infection |journal=J. Hepatol. |volume=44 |issue=1 Suppl |pages=S6–9 |year=2006 |pmid=16352363 |doi=10.1016/j.jhep.2005.11.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0168-8278(05)00726-9 |accessdate=2012-03-29}}</ref> In countries with intermediate and high HBV endemicity, the main routes of transmission of HBV are perinatal or in early childhood; in these countries HBV co infection rates are 10-20%.<ref name="pmid18492625">{{cite journal |author=Lee HC, Ko NY, Lee NY, Chang CM, Ko WC |title=Seroprevalence of viral hepatitis and sexually transmitted disease among adults with recently diagnosed HIV infection in Southern Taiwan, 2000-2005: upsurge in hepatitis C virus infections among injection drug users |journal=J. Formos. Med. Assoc. |volume=107 |issue=5 |pages=404–11 |year=2008 |month=May |pmid=18492625 |doi=10.1016/S0929-6646(08)60106-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0929-6646(08)60106-0 |accessdate=2012-03-29}}</ref><ref name="pmid18555534">{{cite journal |author=Nyirenda M, Beadsworth MB, Stephany P, Hart CA, Hart IJ, Munthali C, Beeching NJ, Zijlstra EE |title=Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi |journal=J. Infect. |volume=57 |issue=1 |pages=72–7 |year=2008 |month=July |pmid=18555534 |doi=10.1016/j.jinf.2008.05.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0163-4453(08)00167-9 |accessdate=2012-03-29}}</ref><ref name="pmid18551596">{{cite journal |author=Diop-Ndiaye H, Touré-Kane C, Etard JF, Lô G, Diaw P, Ngom-Gueye NF, Gueye PM, Ba-Fall K, Ndiaye I, Sow PS, Delaporte E, Mboup S |title=Hepatitis B, C seroprevalence and delta viruses in HIV-1 Senegalese patients at HAART initiation (retrospective study) |journal=J. Med. Virol. |volume=80 |issue=8 |pages=1332–6 |year=2008 |month=August |pmid=18551596 |doi=10.1002/jmv.21236 |url=http://dx.doi.org/10.1002/jmv.21236 |accessdate=2012-03-29}}</ref>
| | ==[[HIV coinfection with hepatitis b overview|Overview]]== |
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| ==Natural History== | | ==[[HIV coinfection with hepatitis b pathophysiology|Pathophysiology]]== |
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| The rate of progression and complications from viral hepatitis are accelerated in patients with HIV co infection.<ref name="pmid16964824">{{cite journal |author=Puoti M, Cozzi-Lepri A, Paraninfo G, Arici C, Moller NF, Lundgren JD, Ledergerber B, Rickenbach M, Suarez-Lozano I, Garrido M, Dabis F, Winnock M, Milazzo L, Gervais A, Raffi F, Gill J, Rockstroh J, Ourishi N, Mussini C, Castagna A, De Luca A, Monforte A |title=Impact of lamivudine on the risk of liver-related death in 2,041 HBsAg- and HIV-positive individuals: results from an inter-cohort analysis |journal=Antivir. Ther. (Lond.) |volume=11 |issue=5 |pages=567–74 |year=2006 |pmid=16964824 |doi= |url= |accessdate=2012-03-29}}</ref><ref name="pmid19399813">{{cite journal |author=Thio CL |title=Hepatitis B and human immunodeficiency virus coinfection |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S138–45 |year=2009 |month=May |pmid=19399813 |doi=10.1002/hep.22883 |url=http://dx.doi.org/10.1002/hep.22883 |accessdate=2012-03-29}}</ref> After acquiring HBV infection, HIV infected individuals are 6 times more likely to develop chronic hepatitis B than HIV negative individuals.<ref name="pmid2019762">{{cite journal |author=Bodsworth NJ, Cooper DA, Donovan B |title=The influence of human immunodeficiency virus type 1 infection on the development of the hepatitis B virus carrier state |journal=J. Infect. Dis. |volume=163 |issue=5 |pages=1138–40 |year=1991 |month=May |pmid=2019762 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=2019762 |accessdate=2012-03-29}}</ref><ref name="pmid1825315">{{cite journal |author=Hadler SC, Judson FN, O'Malley PM, Altman NL, Penley K, Buchbinder S, Schable CA, Coleman PJ, Ostrow DN, Francis DP |title=Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection |journal=J. Infect. Dis. |volume=163 |issue=3 |pages=454–9 |year=1991 |month=March |pmid=1825315 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=1825315 |accessdate=2012-03-29}}</ref><ref name="pmid10795602">{{cite journal |author=Gatanaga H, Yasuoka A, Kikuchi Y, Tachikawa N, Oka S |title=Influence of prior HIV-1 infection on the development of chronic hepatitis B infection |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=19 |issue=3 |pages=237–9 |year=2000 |month=March |pmid=10795602 |doi= |url=http://link.springer.de/link/service/journals/10096/bibs/0019003/00190237.htm |accessdate=2012-03-29}}</ref> This was more
| | ==[[HIV coinfection with hepatitis b causes|Causes]]== |
| likely to occur in HIV infected men with lower CD4 cells. Decreased rates of clearance of HBeAg and increased HBV replication are also seen, with higher HBV DNA viral load.<ref name="pmid10094979">{{cite journal |author=Colin JF, Cazals-Hatem D, Loriot MA, Martinot-Peignoux M, Pham BN, Auperin A, Degott C, Benhamou JP, Erlinger S, Valla D, Marcellin P |title=Influence of human immunodeficiency virus infection on chronic hepatitis B in homosexual men |journal=Hepatology |volume=29 |issue=4 |pages=1306–10 |year=1999 |month=April |pmid=10094979 |doi=10.1002/hep.510290447 |url=http://dx.doi.org/10.1002/hep.510290447 |accessdate=2012-03-29}}</ref><ref name="pmid9108941">{{cite journal |author=Gilson RJ, Hawkins AE, Beecham MR, Ross E, Waite J, Briggs M, McNally T, Kelly GE, Tedder RS, Weller IV |title=Interactions between HIV and hepatitis B virus in homosexual men: effects on the natural history of infection |journal=AIDS |volume=11 |issue=5 |pages=597–606 |year=1997 |month=April |pmid=9108941 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0269-9370&volume=11&issue=5&spage=597 |accessdate=2012-03-29}}</ref><ref name="pmid3643160">{{cite journal |author=Krogsgaard K, Lindhardt BO, Nielson JO, Andersson P, Kryger P, Aldershvile J, Gerstoft J, Pedersen C |title=The influence of HTLV-III infection on the natural history of hepatitis B virus infection in male homosexual HBsAg carriers |journal=Hepatology |volume=7 |issue=1 |pages=37–41 |year=1987 |pmid=3643160 |doi= |url= |accessdate=2012-03-29}}</ref> 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.<ref name="pmid3807959">{{cite journal |author=Biggar RJ, Goedert JJ, Hoofnagle J |title=Accelerated loss of antibody to hepatitis B surface antigen among immunodeficient homosexual men infected with HIV |journal=N. Engl. J. Med. |volume=316 |issue=10 |pages=630–1 |year=1987 |month=March |pmid=3807959 |doi=10.1056/NEJM198703053161015 |url=http://www.nejm.org/doi/abs/10.1056/NEJM198703053161015?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-03-29}}</ref><ref name="pmid3146272">{{cite journal |author=Laukamm-Josten U, Müller O, Bienzle U, Feldmeier H, Uy A, Guggenmoos-Holzmann I |title=Decline of naturally acquired antibodies to hepatitis B surface antigen in HIV-1 infected homosexual men |journal=AIDS |volume=2 |issue=5 |pages=400–1 |year=1988 |month=October |pmid=3146272 |doi= |url= |accessdate=2012-03-29}}</ref>
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| HIV also hastens the progression of HBV related liver disease. [[Cirrhosis]] is more common despite lower ALT levels than in HBV mono-infection and is also more common with lower [[CD4]] counts.<ref name="pmid10094979">{{cite journal |author=Colin JF, Cazals-Hatem D, Loriot MA, Martinot-Peignoux M, Pham BN, Auperin A, Degott C, Benhamou JP, Erlinger S, Valla D, Marcellin P |title=Influence of human immunodeficiency virus infection on chronic hepatitis B in homosexual men |journal=Hepatology |volume=29 |issue=4 |pages=1306–10|year=1999 |month=April |pmid=10094979 |doi=10.1002/hep.510290447 |url=http://dx.doi.org/10.1002/hep.510290447|accessdate=2012-03-29}}</ref><ref name="pmid12454838">{{cite journal |author=Di Martino V, Thevenot T, Colin JF, Boyer N, Martinot M, Degos F, Coulaud JP, Vilde JL, Vachon F, Degott C, Valla D, Marcellin P |title=Influence of HIV infection on the response to interferon therapy and the long-term outcome of chronic hepatitis B |journal=Gastroenterology |volume=123 |issue=6 |pages=1812–22 |year=2002 |month=December |pmid=12454838 |doi=10.1053/gast.2002.37061 |url=http://linkinghub.elsevier.com/retrieve/pii/S0016508502004535 |accessdate=2012-03-29}}</ref>
| | ==[[HIV coinfection with hepatitis b differential diagnosis|Differentiating HIV coinfection with hepatitis b from other Diseases]]== |
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| ===Complications=== | | ==[[HIV coinfection with hepatitis b epidemiology and demographics|Epidemiology and Demographics]]== |
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| Following initiation of [[antiretroviral therapy]] (ART), [[immune reconstitution inflammatory syndrome]] (IRIS) may occur which can lead to worsening liver disease including hepatic decompensation. In addition, after discontinuation of an ART regimen containing anti-HBV agents, reactivation of hepatitis B can occur.
| | ==[[HIV coinfection with hepatitis b risk factors|Risk Factors]]== |
| ALT elevations occurred in 29% of 147 patients within 6 months of withdrawal.<ref name="pmid18795964">{{cite journal |author=Bellini C, Keiser O, Chave JP, Evison J, Fehr J, Kaiser L, Weber R, Vernazza P, Bernasconi E, Telenti A, Cavassini M |title=Liver enzyme elevation after lamivudine withdrawal in HIV-hepatitis B virus co-infected patients: the Swiss HIV Cohort Study |journal=HIV Med. |volume=10 |issue=1 |pages=12–8 |year=2009 |month=January |pmid=18795964 |doi=10.1111/j.1468-1293.2008.00646.x |url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1464-2662&date=2009&volume=10&issue=1&spage=12 |accessdate=2012-03-29}}</ref> If reactivation occurs, resuming an agent that is active against HBV is required.
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| HIV-HBV co-infected men are greater than 17 times more likely to die of liver related causes compared to those mono-infected with HBV.<ref name="pmid12493258">{{cite journal |author=Thio CL, Seaberg EC, Skolasky R, Phair J, Visscher B, Muñoz A, Thomas DL |title=HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS) |journal=Lancet |volume=360 |issue=9349 |pages=1921–6 |year=2002 |month=December |pmid=12493258 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673602119131 |accessdate=2012-03-29}}</ref> For individuals on ART, co infection with chronic hepatitis B increases the risk of hepatotoxicity from ART three-fold to five-fold.<ref name="pmid12626885">{{cite journal |author=Puoti M, Torti C, Ripamonti D, Castelli F, Zaltron S, Zanini B, Spinetti A, Putzolu V, Casari S, Tomasoni L, Quiros-Roldan E, Favret M, Berchich L, Grigolato P, Callea F, Carosi G |title=Severe hepatotoxicity during combination antiretroviral treatment: incidence, liver histology, and outcome |journal=J. Acquir. Immune Defic. Syndr. |volume=32 |issue=3 |pages=259–67 |year=2003 |month=March |pmid=12626885 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1525-4135&volume=32&issue=3&spage=259 |accessdate=2012-03-29}}</ref><ref name="pmid10632283">{{cite journal |author=Sulkowski MS, Thomas DL, Chaisson RE, Moore RD |title=Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection |journal=JAMA |volume=283 |issue=1 |pages=74–80 |year=2000 |month=January |pmid=10632283 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=10632283 |accessdate=2012-03-29}}</ref><ref name="pmid14628283">{{cite journal |author=Livry C, Binquet C, Sgro C, Froidure M, Duong M, Buisson M, Grappin M, Quantin C, Portier H, Chavanet P, Piroth L |title=Acute liver enzyme elevations in HIV-1-infected patients |journal=HIV Clin Trials |volume=4 |issue=6 |pages=400–10 |year=2003 |pmid=14628283 |doi= |url=http://thomasland.metapress.com/openurl.asp?genre=article&issn=1528-4336&volume=4&issue=6&spage=400 |accessdate=2012-03-29}}</ref>
| | ==[[HIV coinfection with hepatitis b screening|Screening]]== |
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| It is unclear at present if the risk of hepatocellular carcinoma (HCC) is increased, but there is some evidence that HIV infected individuals with lower CD4 counts are at greater risk of developing HCC.<ref name="pmid18832877">{{cite journal |author=Clifford GM, Rickenbach M, Polesel J, Dal Maso L, Steffen I, Ledergerber B, Rauch A, Probst-Hensch NM, Bouchardy C, Levi F, Franceschi S |title=Influence of HIV-related immunodeficiency on the risk of hepatocellular carcinoma |journal=AIDS |volume=22 |issue=16 |pages=2135–41 |year=2008 |month=October |pmid=18832877 |doi=10.1097/QAD.0b013e32831103ad |url= |accessdate=2012-03-29}}</ref>
| | ==[[HIV coinfection with hepatitis b natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
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| Accurate assessment of HBV infection in HIV co-infected individuals is necessary in order to base therapeutic decisions. <ref name="pmid19399813">{{cite journal |author=Thio CL |title=Hepatitis B and human immunodeficiency virus coinfection |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S138–45 |year=2009 |month=May|pmid=19399813 |doi=10.1002/hep.22883 |url=http://dx.doi.org/10.1002/hep.22883 |accessdate=2012-03-29}}</ref>
| | [[HIV coinfection with hepatitis b history and symptoms|History and Symptoms]] | [[HIV coinfection with hepatitis b physical examination|Physical Examination]] | [[HIV coinfection with hepatitis b laboratory findings|Laboratory Findings]] | [[HIV coinfection with hepatitis b other diagnostic studies|Other Diagnostic Studies]] |
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| | ==Treatment== |
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| | [[HIV coinfection with hepatitis b medical therapy|Medical Therapy]] | [[HIV coinfection with hepatitis b prevention|Prevention]] | [[HIV coinfection with hepatitis b cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[HIV coinfection with hepatitis b future or investigational therapies|Future or Investigational Therapies]] |
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| WHO advocates HBsAg testing especially in areas of high HBV prevalence.
| | ==Case Studies== |
| | [[HIV coinfection with hepatitis b case study one|Case #1]] |
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| ==Reference== | | ==Related Chapters== |
| {{reflist|2}}
| | * [[Coinfection]] |
| | * [[AIDS]] |
| | * [[HIV disease]] |
| | * [[Hepatitis C with HIV coinfection]] |
| | * [[Tuberculosis and HIV coinfection]] |
| | * [[HIV and tuberculosis coinfection : drug interaction]] |
| | * [[HIV and pregnancy]] |
| | * [[Hepatitis]] |
| | * [[Jaundice]] |
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| [[Category:Hepatitis|B]]
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Infectious disease]]
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| [[Category:Disease]] | | [[Category:Disease]] |
| | {{WH}} |
| | {{WS}} |