HIV coinfection with hepatitis b

Jump to navigation Jump to search

Hepatitis Main Page

Hepatitis B

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Hepatitis B from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Ultrasound

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

HIV coinfection with hepatitis b On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of HIV coinfection with hepatitis b

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on HIV coinfection with hepatitis b

CDC on HIV coinfection with hepatitis b

HIV coinfection with hepatitis b in the news

Blogs on HIV coinfection with hepatitis b

Directions to Hospitals Treating Hepatitis B

Risk calculators and risk factors for HIV coinfection with hepatitis b

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Ujjwal Rastogi, MBBS [2]

Overview

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.[1] 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.[1]

Epidemiology

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.[2] 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%.[3][4][5]

Natural History

The rate of progression and complications from viral hepatitis are accelerated in patients with HIV co infection.[6][7] After acquiring HBV infection, HIV infected individuals are 6 times more likely to develop chronic hepatitis B than HIV negative individuals.[8][9][10] This was more 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.[11][12][13] 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.[14][15]

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.[11][16]

Complications

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. ALT elevations occurred in 29% of 147 patients within 6 months of withdrawal.[17] If reactivation occurs, resuming an agent that is active against HBV is required.

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.[18] For individuals on ART, co infection with chronic hepatitis B increases the risk of hepatotoxicity from ART three-fold to five-fold.[19][20][21]

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.[22]

Diagnosis

Accurate assessment of HBV infection in HIV co-infected individuals is necessary in order to base therapeutic decisions. [7]

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 enzymes, liver biopsy) may not be widely available in many resource limited countries.

Liver biopsy remains the gold standard for assessing disease severity in HIV-HBV co infection. Non-invasive markers are also available but none have been widely studied in co-infected patients.

Hoffman and Thio provide 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. Chronic HBV carriers with HBeAg positivity may benefit from starting anti-HBV therapy early. [1]

Screening

For HIV infected individuals with chronic HBV, additional screening for co infection 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. [7]

Treatment

Goals of treatment

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.[23] 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.

HBV: In mono-infected patients, HBV therapy can reduce the risk of developing complications of liver disease.

Reference

  1. ↑ 1.0 1.1 1.2 Hoffmann CJ, Thio CL (2007). "Clinical implications of HIV and hepatitis B co-infection in Asia and Africa". Lancet Infect Dis. 7 (6): 402–9. doi:10.1016/S1473-3099(07)70135-4. PMID 17521593. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  2. ↑ Alter MJ (2006). "Epidemiology of viral hepatitis and HIV co-infection". J. Hepatol. 44 (1 Suppl): S6–9. doi:10.1016/j.jhep.2005.11.004. PMID 16352363. Retrieved 2012-03-29.
  3. ↑ Lee HC, Ko NY, Lee NY, Chang CM, Ko WC (2008). "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". J. Formos. Med. Assoc. 107 (5): 404–11. doi:10.1016/S0929-6646(08)60106-0. PMID 18492625. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  4. ↑ Nyirenda M, Beadsworth MB, Stephany P, Hart CA, Hart IJ, Munthali C, Beeching NJ, Zijlstra EE (2008). "Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi". J. Infect. 57 (1): 72–7. doi:10.1016/j.jinf.2008.05.004. PMID 18555534. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  5. ↑ 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 (2008). "Hepatitis B, C seroprevalence and delta viruses in HIV-1 Senegalese patients at HAART initiation (retrospective study)". J. Med. Virol. 80 (8): 1332–6. doi:10.1002/jmv.21236. PMID 18551596. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  6. ↑ 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 (2006). "Impact of lamivudine on the risk of liver-related death in 2,041 HBsAg- and HIV-positive individuals: results from an inter-cohort analysis". Antivir. Ther. (Lond.). 11 (5): 567–74. PMID 16964824. |access-date= requires |url= (help)
  7. ↑ 7.0 7.1 7.2 Thio CL (2009). "Hepatitis B and human immunodeficiency virus coinfection". Hepatology. 49 (5 Suppl): S138–45. doi:10.1002/hep.22883. PMID 19399813. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  8. ↑ Bodsworth NJ, Cooper DA, Donovan B (1991). "The influence of human immunodeficiency virus type 1 infection on the development of the hepatitis B virus carrier state". J. Infect. Dis. 163 (5): 1138–40. PMID 2019762. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  9. ↑ Hadler SC, Judson FN, O'Malley PM, Altman NL, Penley K, Buchbinder S, Schable CA, Coleman PJ, Ostrow DN, Francis DP (1991). "Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection". J. Infect. Dis. 163 (3): 454–9. PMID 1825315. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  10. ↑ Gatanaga H, Yasuoka A, Kikuchi Y, Tachikawa N, Oka S (2000). "Influence of prior HIV-1 infection on the development of chronic hepatitis B infection". Eur. J. Clin. Microbiol. Infect. Dis. 19 (3): 237–9. PMID 10795602. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  11. ↑ 11.0 11.1 Colin JF, Cazals-Hatem D, Loriot MA, Martinot-Peignoux M, Pham BN, Auperin A, Degott C, Benhamou JP, Erlinger S, Valla D, Marcellin P (1999). "Influence of human immunodeficiency virus infection on chronic hepatitis B in homosexual men". Hepatology. 29 (4): 1306–10. doi:10.1002/hep.510290447. PMID 10094979. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  12. ↑ Gilson RJ, Hawkins AE, Beecham MR, Ross E, Waite J, Briggs M, McNally T, Kelly GE, Tedder RS, Weller IV (1997). "Interactions between HIV and hepatitis B virus in homosexual men: effects on the natural history of infection". AIDS. 11 (5): 597–606. PMID 9108941. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  13. ↑ Krogsgaard K, Lindhardt BO, Nielson JO, Andersson P, Kryger P, Aldershvile J, Gerstoft J, Pedersen C (1987). "The influence of HTLV-III infection on the natural history of hepatitis B virus infection in male homosexual HBsAg carriers". Hepatology. 7 (1): 37–41. PMID 3643160. |access-date= requires |url= (help)
  14. ↑ Biggar RJ, Goedert JJ, Hoofnagle J (1987). "Accelerated loss of antibody to hepatitis B surface antigen among immunodeficient homosexual men infected with HIV". N. Engl. J. Med. 316 (10): 630–1. doi:10.1056/NEJM198703053161015. PMID 3807959. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  15. ↑ Laukamm-Josten U, Müller O, Bienzle U, Feldmeier H, Uy A, Guggenmoos-Holzmann I (1988). "Decline of naturally acquired antibodies to hepatitis B surface antigen in HIV-1 infected homosexual men". AIDS. 2 (5): 400–1. PMID 3146272. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  16. ↑ 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 (2002). "Influence of HIV infection on the response to interferon therapy and the long-term outcome of chronic hepatitis B". Gastroenterology. 123 (6): 1812–22. doi:10.1053/gast.2002.37061. PMID 12454838. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  17. ↑ Bellini C, Keiser O, Chave JP, Evison J, Fehr J, Kaiser L, Weber R, Vernazza P, Bernasconi E, Telenti A, Cavassini M (2009). "Liver enzyme elevation after lamivudine withdrawal in HIV-hepatitis B virus co-infected patients: the Swiss HIV Cohort Study". HIV Med. 10 (1): 12–8. doi:10.1111/j.1468-1293.2008.00646.x. PMID 18795964. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  18. ↑ Thio CL, Seaberg EC, Skolasky R, Phair J, Visscher B, Muñoz A, Thomas DL (2002). "HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS)". Lancet. 360 (9349): 1921–6. PMID 12493258. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  19. ↑ 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 (2003). "Severe hepatotoxicity during combination antiretroviral treatment: incidence, liver histology, and outcome". J. Acquir. Immune Defic. Syndr. 32 (3): 259–67. PMID 12626885. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  20. ↑ Sulkowski MS, Thomas DL, Chaisson RE, Moore RD (2000). "Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection". JAMA. 283 (1): 74–80. PMID 10632283. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
  21. ↑ Livry C, Binquet C, Sgro C, Froidure M, Duong M, Buisson M, Grappin M, Quantin C, Portier H, Chavanet P, Piroth L (2003). "Acute liver enzyme elevations in HIV-1-infected patients". HIV Clin Trials. 4 (6): 400–10. PMID 14628283. Retrieved 2012-03-29.
  22. ↑ Clifford GM, Rickenbach M, Polesel J, Dal Maso L, Steffen I, Ledergerber B, Rauch A, Probst-Hensch NM, Bouchardy C, Levi F, Franceschi S (2008). "Influence of HIV-related immunodeficiency on the risk of hepatocellular carcinoma". AIDS. 22 (16): 2135–41. doi:10.1097/QAD.0b013e32831103ad. PMID 18832877. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  23. ↑ Puoti M, Spinetti A, Ghezzi A, Donato F, Zaltron S, Putzolu V, Quiros-Roldan E, Zanini B, Casari S, Carosi G (2000). "Mortality for liver disease in patients with HIV infection: a cohort study". J. Acquir. Immune Defic. Syndr. 24 (3): 211–7. PMID 10969344. Retrieved 2012-03-29. Unknown parameter |month= ignored (help)
Retrieved from "https://www.wikidoc.org/index.php?title=HIV_coinfection_with_hepatitis_b&oldid=637938"