Sandbox/HIV: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 17: Line 17:
| style="padding: 5px 5px; background: #F5F5F5;" |'''Hepatitis B'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Hepatitis B'''
| style="padding: 5px 5px; background: #F5F5F5;" |''Hepatitis B virus (HBV) is the leading cause of chronic liver disease worldwide.<ref name="pmid9392700">{{cite journal| author=Lee WM| title=Hepatitis B virus infection. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 24 | pages= 1733-45 | pmid=9392700 | doi=10.1056/NEJM199712113372406 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9392700  }} </ref>,<ref name="pmid7631637">{{cite journal| author=Levine OS, Vlahov D, Koehler J, Cohn S, Spronk AM, Nelson KE| title=Seroepidemiology of hepatitis B virus in a population of injecting drug users. Association with drug injection patterns. | journal=Am J Epidemiol | year= 1995 | volume= 142 | issue= 3 | pages= 331-41 | pmid=7631637 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7631637  }} </ref> Globally and in North
| style="padding: 5px 5px; background: #F5F5F5;" |''Hepatitis B virus (HBV) is the leading cause of chronic liver disease worldwide.<ref name="pmid9392700">{{cite journal| author=Lee WM| title=Hepatitis B virus infection. | journal=N Engl J Med | year= 1997 | volume= 337 | issue= 24 | pages= 1733-45 | pmid=9392700 | doi=10.1056/NEJM199712113372406 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9392700  }} </ref>,<ref name="pmid7631637">{{cite journal| author=Levine OS, Vlahov D, Koehler J, Cohn S, Spronk AM, Nelson KE| title=Seroepidemiology of hepatitis B virus in a population of injecting drug users. Association with drug injection patterns. | journal=Am J Epidemiol | year= 1995 | volume= 142 | issue= 3 | pages= 331-41 | pmid=7631637 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7631637  }} </ref> Globally and in North
America, approximately 10% of HIV-infected patients have evidence of chronic HBV infection.3-5
America, approximately 10% of HIV-infected patients have evidence of chronic HBV infection. <ref name="pmid16702586.">{{cite journal| author=Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ| title=The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. | journal=Ann Intern Med | year= 2006 | volume= 144 | issue= 10 | pages= 705-14 | pmid=16702586. | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16702586  }} </ref><ref name="pmid10849261.">{{cite journal| author=Blatt LM, Mutchnick MG, Tong MJ, Klion FM, Lebovics E, Freilich B et al.| title=Assessment of hepatitis C virus RNA and genotype from 6807 patients with chronic hepatitis C in the United States. | journal=J Viral Hepat | year= 2000 | volume= 7 | issue= 3 | pages= 196-202 | pmid=10849261. | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10849261  }} </ref><ref name="pmid10433578.">{{cite journal| author=Staples CT, Rimland D, Dudas D| title=Hepatitis C in the HIV (human immunodeficiency virus) Atlanta V.A. (Veterans Affairs Medical Center) Cohort Study (HAVACS): the effect of coinfection on survival. | journal=Clin Infect Dis | year= 1999 | volume= 29 | issue= 1 | pages= 150-4 | pmid=10433578. | doi=10.1086/520144 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10433578  }} </ref>In countries with a low prevalence of endemic chronic HBV infection, the virus is transmitted primarily
In countries with a low prevalence of endemic chronic HBV infection, the virus is transmitted primarily
through sexual contact and injection drug use, whereas perinatal and early childhood exposures are responsible
through sexual contact and injection drug use, whereas perinatal and early childhood exposures are responsible
for most HBV transmission in higher prevalence regions. Although the general modes of transmission are
for most HBV transmission in higher prevalence regions. Although the general modes of transmission are

Revision as of 21:19, 16 October 2014

HIV co infections
Coinfection Epidemeology Clinical features Diagnosis Treatment Prevention
' ' ' ' '
Hepatitis B Hepatitis B virus (HBV) is the leading cause of chronic liver disease worldwide.[1],[2] Globally and in North

America, approximately 10% of HIV-infected patients have evidence of chronic HBV infection. [3][4][5]In countries with a low prevalence of endemic chronic HBV infection, the virus is transmitted primarily through sexual contact and injection drug use, whereas perinatal and early childhood exposures are responsible for most HBV transmission in higher prevalence regions. Although the general modes of transmission are similar to HIV, HBV is transmitted more efficiently than HIV.1,2,6 HBV has an average incubation period of 90 days (range 60–150 days) from exposure to onset of jaundice and 60 days (range 40–90 days) from exposure to onset of abnormal liver enzymes. Genotypes of HBV (A–H) have been identified with different geographic distributions. Genotype A is most common among patients in North America and Western Europe.

Acute infection may be asymptomatic. Symptoms may include right upper quadrant abdominal pain, nausea, vomiting, fever, and arthralgias with or without jaundice. Most patients with chronic HBV infection are

asymptomatic or have non-specific symptoms, such as fatigue, until they develop cirrhosis and signs of portal hypertension (i.e., ascites, variceal bleeding, coagulopathy, jaundice, or hepatic encephalopathy). Hepatocellular carcinoma (HCC) is asymptomatic in its early stages and usually, but not always, occurs in the setting of hepatitis-B- or hepatitis-C-related cirrhosis.

  • All HIV-infected patients should be tested for HBV infection. Initial testing should include serologic testing ,for surface antigen (HBsAg), hepatitis B core antibody (anti-HBc total), and hepatitis B surface antibody (anti-HBs).
  • Chronic HBV infection is defined as persistent HbsAg detected on 2 occasions at least 6 months apart. Patients

with chronic HBV infection should be further tested for HBV e-antigen (HBeAg), antibody to HBeAg (anti-HBe), and HBV DNA

  • The inactive chronic hepatitis B state is characterized by a

negative HBeAg, normal ALT levels, and an HBV DNA level <2,000 international units/mL.

  • Patients diagnosed with chronic HBV infection should have a complete blood count, ALT, aspartate

aminotransferase (AST), albumin and bilirubin levels, and prothrombin time monitored at baseline and every 6 months thereafter to assess severity and progression of liver disease

  • Liver biopsy with histologic examination remains a valuable tool for characterizing the activity and severity of

chronic hepatitis B and may provide important information in monitoring disease progression, guiding treatment, and excluding other diseases

  • The ultimate treatment goals in HIV/HBV co-infection are the same as for HBV monoinfection: to prevent , disease progression and to reduce HBV-related morbidity and mortality. Anti-HBV therapy is indicated for elevated ALT and elevated HBV DNA >2,000 international units/mL or significant fibrosis (AI

24.

  • For HIV/HBV co-infected individuals, ART must include two drugs active against HBV, preferably tenofovir .and emtricitabine, regardless of the level of HBV DNA (AIII). Such a regimen will reduce the likelihood of

immune reconstitution inflammatory syndrome (IRIS) against HBV

  • HBV is primarily transmitted by percutaneous or mucosal exposure to infectious blood or body fluids. Therefore, HIV-infected patients should be counseled about transmission risks for HBV and avoidance of behaviors associated with such transmission. Counseling should emphasize the transmission risks associated with sharing needles and syringes, tattooing or body-piercing, and sexual transmission.
  • All household members and sexual contacts of patients with HBV should be screened and all susceptible contacts should receive both hepatitis A and B vaccines regardless of whether they are HIV infected.
  • Hepatitis B immunization is the most effective way to prevent HBV infection and its consequences
  • Most HIV-infected patients with isolated anti-HBc are HBV DNA negative and not immune to HBV infection. They should be vaccinated with a complete series of hepatitis B vaccine followed by anti-HBs testing (BII).34,35
  • Hepatitis A vaccination is recommended for all hepatitis A antibody-negative patients who have chronic liver disease, are men who have sex with men, or who are injection drug users
  • Patients with chronic hepatitis B disease should be advised to avoid alcohol consumption
Hepatitis C HCV is spread through the blood of a person infected with HCV. Sharing drug injection equipment with a person infected with HCV is the main way people get HCV, butHCV can also be transmitted during unprotected sex. (Before widespread screening of the blood supply began in 1992, HCV was also commonly spread through blood transfusions and organ transplants.) '
' ' '
  1. Lee WM (1997). "Hepatitis B virus infection". N Engl J Med. 337 (24): 1733–45. doi:10.1056/NEJM199712113372406. PMID 9392700.
  2. Levine OS, Vlahov D, Koehler J, Cohn S, Spronk AM, Nelson KE (1995). "Seroepidemiology of hepatitis B virus in a population of injecting drug users. Association with drug injection patterns". Am J Epidemiol. 142 (3): 331–41. PMID 7631637.
  3. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ (2006). "The prevalence of hepatitis C virus infection in the United States, 1999 through 2002". Ann Intern Med. 144 (10): 705–14. PMID 16702586. Check |pmid= value (help).
  4. Blatt LM, Mutchnick MG, Tong MJ, Klion FM, Lebovics E, Freilich B; et al. (2000). "Assessment of hepatitis C virus RNA and genotype from 6807 patients with chronic hepatitis C in the United States". J Viral Hepat. 7 (3): 196–202. PMID 10849261. Check |pmid= value (help).
  5. Staples CT, Rimland D, Dudas D (1999). "Hepatitis C in the HIV (human immunodeficiency virus) Atlanta V.A. (Veterans Affairs Medical Center) Cohort Study (HAVACS): the effect of coinfection on survival". Clin Infect Dis. 29 (1): 150–4. doi:10.1086/520144. PMID 10433578. Check |pmid= value (help).