ReviewViral hepatitis and HIV co-infection
Introduction
Due to similar routes of transmission, co-infection of HIV with other sexual and blood-borne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV) and/or hepatitis delta virus (HDV) is relatively common. Of the 35 million people living with HIV worldwide, around 20% (∼7 million) had chronic hepatitis C. This population is mainly represented by individuals with past history of intravenous drug use, hemophiliacs and recipients of contaminated blood. With respect to HBV, the situation is slightly different, with rates of chronicity in HIV+ patients ranging from 5% in Western countries to 20% in some HBV endemic regions in Sub-Saharan Africa and South East Asia. Around 15% of HBV–HIV co-infected patients worldwide are superinfected by the delta virus. Individuals with multiple viral hepatitis are a minority, with complex viral interference phenomena and generally poor clinical outcome. Fig. 1 records the overlap of HIV, HBV and HCV epidemics.
Section snippets
Hepatitis B and HIV
Among the estimated 35 million persons currently living with HIV worldwide, approximately 3 million are chronically infected with HBV (Soriano et al., 2008). The prevalence of HBV–HIV co-infection demonstrates geographical variations, largely due to differences in the predominant routes of transmission. Studies focused on the natural history of chronic hepatitis B in the HIV setting have demonstrated an increased risk of liver disease progression and death in co-infected individuals (Thio et
Hepatitis C and HIV
Of the 35 million people currently living with HIV worldwide around 20% (∼7 million) has chronic hepatitis C (Fig. 1). This population is mainly represented by individuals with past history of intravenous drug use, hemophiliacs and recipients of contaminated blood.
Delta hepatitis and HIV
HDV is a defective agent that only infects HBsAg+ carriers. Hepatitis delta is the most aggressive form of chronic viral hepatitis, with even further faster progression to liver cirrhosis when associated to HBV or HCV infections. This poor prognosis is even more pronounced in HIV+ patients. The prevalence of anti-delta antibodies in HIV+ patients with HBsAg+ ranges from 15% to 50%, depending on geographical region and risk group category. In Western countries, hepatitis delta is more frequent
Multiple viral hepatitis and HIV
The prevalence of multiple viral hepatitis (HBV/HCV, HBV/HDV, HCV/HBV/HDV) in HIV patients is below 5% in developed countries, but higher than in the general population. In patients with HDVAb+, replication of this virus uniformly predominates over others, with low or undetectable HBV and/or HCV viremia, and rapid progression to cirrhosis (Mathurin et al., 2000). Patients carrying HBV/HCV infections seem to present a reciprocal inhibition of virus replication, predominating one virus over the
References (102)
- et al.
Short statement of the first European Consensus Conference on the treatment of chronic hepatitis B and C in HIV co-infected patients
J. Hepatol.
(2005) - et al.
Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon-alfa 2a plus ribavirin
Gastroenterology
(2006) - et al.
Influence of HIV infection on the response to interferon therapy and the long-term outcome of chronic hepatitis B
Gastroenterology
(2002) - et al.
Predicting cirrhosis risk based on the level of circulating hepatitis B virus viral load
Gastroenterology
(2006) - et al.
Risk and predictors of mortality associated with chronic hepatitis B infection
Clin. Gastroenterol. Hepatol.
(2007) - et al.
A 1-year trial of telbivudine, lamivudine, and the combination in patients with hepatitis B e antigen-positive chronic hepatitis B
Gastroenterology
(2005) - et al.
Management of patients co-infected with hepatitis B virus and HIV
Lancet Infect. Dis.
(2005) - et al.
Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients
Gastroenterology
(2005) - et al.
Peginterferon alfa-2a plus ribavirin for 72 weeks in chronic hepatitis C patients without a response by week 4
Gastroenterology
(2006) - et al.
Viral kinetics in hepatitis C or hepatitis C/HIV-infected patients
Gastroenterology
(2005)