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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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| Coinfection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) is common due to shared routes of transmission. The impact of coinfection 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 [[Hepatitis B natural history#Chronic infection|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 [[Human Immunodeficiency Virus#Transmission|sexual]] or [[Human Immunodeficiency Virus#Transmission|percutaneous transmission]]. In areas of low endemicity, the prevalence of chronic coinfection 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 coinfection 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 coinfection.<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 [[Hepatitis B laboratory tests#Lab Tests|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 [[Cirrhosis#Decompensated cirrhosis|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 coinfected 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, coinfection 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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| WHO advocates HBsAg testing especially in areas of high HBV prevalence; but additional testing for HBV markers such as HBeAg and HBV DNA and to assess stage of liver disease (e.g. [[Liver function tests|liver enzymes]], liver [[biopsy]]) may not be widely available in many resource limited countries.
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| Liver biopsy remains the '''gold standard''' for assessing disease severity in HIV-HBV coinfection. Non-invasive markers are also available but none have been widely studied in co-infected patients.
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| Hoffman and Thio provided management recommendations for use in areas with limited resources. They recommend that [[HBsAg]] and liver enzymes be tested before ART, with liver enzymes being repeated once or twice during the first 3 months after commencing ART. Detection of HBV DNA is helpful but may not be available. [[Hepatitis B natural history#Chronic infection|Chronic HBV]] carriers with [[Hepatitis B laboratory tests#Lab Tests|HBeAg]] positivity may benefit from starting [[Hepatitis B medical therapy|anti-HBV therapy]] early. <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>
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| ==Screening==
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| For HIV infected individuals with chronic HBV, additional screening for coinfection with HCV is recommended; [[hepatocellular carcinoma]] screening with [[alpha fetoprotein]] and imaging of liver every 6 months is being suggested by some but the cost benefit of one or both tests as well as the frequency of monitoring in various health economies remain to be assessed. <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>
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| ==Treatment== | | ==Treatment== |
| '''Goals of treatment'''
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| '''HIV:'''Treatment for HIV has resulted in a marked reduction in AIDS-related mortality. As a result, liver disease from HBV and HCV is now becoming a major cause of morbidity and mortality in HIV infected patients.<ref name="pmid10969344">{{cite journal |author=Puoti M, Spinetti A, Ghezzi A, Donato F, Zaltron S, Putzolu V, Quiros-Roldan E, Zanini B, Casari S, Carosi G |title=Mortality for liver disease in patients with HIV infection: a cohort study |journal=J. Acquir. Immune Defic. Syndr. |volume=24 |issue=3 |pages=211–7 |year=2000 |month=July |pmid=10969344 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1525-4135&volume=24&issue=3&spage=211 |accessdate=2012-03-29}}</ref> Therefore the goal of treatment is to optimize anti-HIV therapy in HIV/HBV co-infected patients to improve and/or preserve immune function and reduce HIV associated morbidity and mortality.
| | [[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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| '''HBV:''' In mono-infected patients, HBV therapy can reduce the risk of developing complications of liver disease.<ref name="pmid8618580">{{cite journal |author=Niederau C, Heintges T, Lange S, Goldmann G, Niederau CM, Mohr L, Häussinger D |title=Long-term follow-up of HBeAg-positive patients treated with interferon alfa for chronic hepatitis B |journal=N. Engl. J. Med. |volume=334 |issue=22 |pages=1422–7 |year=1996 |month=May |pmid=8618580 |doi=10.1056/NEJM199605303342202 |url=http://dx.doi.org/10.1056/NEJM199605303342202 |accessdate=2012-03-30}}</ref> <ref name="pmid11481627">{{cite journal |author=Yao FY, Terrault NA, Freise C, Maslow L, Bass NM |title=Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: a comparative study using a matched, untreated cohort |journal=Hepatology |volume=34 |issue=2 |pages=411–6 |year=2001 |month=August |pmid=11481627 |doi=10.1053/jhep.2001.26512 |url=http://dx.doi.org/10.1053/jhep.2001.26512 |accessdate=2012-03-30}}</ref> Natural history studies of chronically infected individuals have linked the risk of progression to cirrhosis and HCC to ongoing HBV replication.
| | ==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}} |