Elsevier

Journal of Hepatology

Volume 48, Issue 2, February 2008, Pages 353-367
Journal of Hepatology

Review
Viral hepatitis and HIV coinfection

https://doi.org/10.1016/j.jhep.2007.11.009Get rights and content

Persons at high risk for human immunodeficiency virus (HIV) infection are also likely to be at risk for other infectious pathogens, including hepatitis B virus (HBV) or hepatitis C virus (HCV). These are bloodborne pathogens transmitted through similar routes; for example, via injection drug use (IDU), sexual contact, or from mother to child during pregnancy or birth. In some settings, the prevalence of coinfection with HBV and/or HCV is high. In the context of effective antiretroviral therapy (ART), liver disease has emerged as a major cause of morbidity and mortality in HIV-infected persons. Further, coinfection with viral hepatitis may complicate the delivery of ART by increasing the risk of drug-related hepatoxicity and impacting the selection of specific agents (e.g., those dually active against HIV and HBV). Expert guidelines developed in the United States and Europe recommend screening of all HIV-infected persons for infection with HCV and HBV and appropriate management of those found to be chronically infected. Treatment strategies for HBV infection include the use of nucleos(t)ide analogues with or without anti-HIV activity and/or peginterferon alfa (PegIFN) whereas HCV treatment is limited to the combination of PegIFN and ribavirin (RBV). Current approaches to management of HIV-infected persons coinfected with HBV or HCV are discussed in this review.

Introduction

Persons at high risk for human immunodeficiency virus (HIV) infection are also likely to be at risk for other infectious pathogens, including hepatitis B virus (HBV) or hepatitis C virus (HCV). These are bloodborne pathogens transmitted through similar routes; for example, via injection drug use (IDU), sexual contact, or from mother to child during pregnancy or birth [1]. In some settings, the prevalence of coinfection with HBV and/or HCV is high [2], [3]. In the context of effective antiretroviral therapy (ART), liver disease has emerged as a major cause of morbidity and mortality in HIV-infected persons [4], [5], [6]. Further, coinfection with viral hepatitis may complicate the delivery of ART by increasing the risk of drug-related hepatoxicity and impacting the selection of specific agents (e.g., those dually active against HIV and HBV) [7]. Expert guidelines developed in the United States and Europe recommend screening of all HIV-infected persons for infection with HCV and HBV and appropriate management of those found to be chronically infected [8], [9], [10], [11]. Treatment strategies for HBV infection include the use of nucleos(t)ide analogues with or without anti-HIV activity and/or peginterferon alfa (PegIFN) whereas HCV treatment is limited to the combination of PegIFN and ribavirin (RBV). Current approaches to management of HIIV-infected persons coinfected with HBV or HCV are discussed in this review.

Section snippets

Epidemiology and natural history

HCV and HIV have similar modes of transmission but the transmission efficiency of each virus differs. HCV is most efficiently spread through exposure to contaminated blood or blood products, particularly injection drug use (IDU). Rates of vertical and perinatal transmission are relatively low (3–6%), although increased ∼2-fold when the mother is HIV-infected [12], [13]. Sexual transmission of HCV is inefficient and the exact risk related to different types of sexual activity is unknown.

Epidemiology and natural history

HBV can be transmitted by sexual intercourse, percutaneous exposure, or from mother to infant. Among persons coinfected with HIV in the United States and Europe, HBV is most often transmitted by sexual intercourse (both heterosexual and between men), followed by IDU [61], [62]. In Asia and sub-Saharan Africa, HBV is principally transmitted from mother to infant or during early childhood. Because the routes of transmission of HIV and HBV are similar, there is evidence of prior HBV infection in

Summary

Due to shared modes of transmission, coinfection with HBV and/or HCV is common among HIV-infected individuals. Current data indicate that HIV coinfection exacerbates the natural history of HCV and HBV infection with decreased immune clearance and more rapid progression of liver disease. In many HIV care settings, liver disease is a leading cause of morbidity and mortality. Guidelines for the management of HIV disease recommend universal screening of HIV-infected persons for chronic hepatitis C

References (110)

  • C.L. Thio et al.

    HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter AIDS Cohort Study (MACS)

    Lancet

    (2002)
  • M.S. Sulkowski et al.

    Hepatotoxicity associated with nevirapine or efavirenz-containing antiretroviral therapy: role of hepatitis C and B infections

    Hepatology

    (2002)
  • V. Di Martino et al.

    Influence of HIV infection on the response to interferon therapy and the long-term outcome of chronic hepatitis B

    Gastroenterology

    (2002)
  • J. Doutreloigne et al.

    Analysis of drug resistant mutations associated with entecavir, tenofovir, adefovir dipivoxil treatment using a novel line probe assay. 42nd European Association for the Study of the Liver, Barcelona, Spain 2007

    J Hepatol

    (2007)
  • C.L. Thio

    Treatment of lamivudine-resistant hepatitis B in HIV-infected persons: is adefovir dipivoxil the answer?

    J Hepatol

    (2006)
  • P. Angus et al.

    Resistance to adefovir dipivoxil therapy associated with development of a novel mutation in the HBV polymerase

    Gastroenterology

    (2003)
  • M.J. Koziel et al.

    Viral hepatitis in HIV infection

    N Engl J Med

    (2007)
  • M.S. Sulkowski et al.

    Hepatitis C and progression of HIV disease

    JAMA

    (2002)
  • K.E. Sherman et al.

    Hepatitis C prevalence in HIV-infected patients: a cross-sectional analysis of the US adult clinical trials group

    Antivir Ther

    (2000)
  • R. Weber et al.

    Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study

    Arch Intern Med

    (2006)
  • K.A. Gebo et al.

    Hospitalization rates differ by hepatitis C status in an urban HIV cohort

    J Acquir Immune Defic Syndr

    (2003)
  • C.S. Graham et al.

    Influence of human immunodeficiency virus infection on the course of hepatitis c virus infection: a meta-analysis

    Clin Infect Dis

    (2001)
  • M.S. Sulkowski et al.

    Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection

    JAMA

    (2000)
  • D.B. Strader et al.

    Diagnosis, management, and treatment of hepatitis C

    Hepatology

    (2004)
  • V. Soriano et al.

    Care of patients coinfected with HIV and hepatitis C virus: 2007 updated recommendations from the HCV–HIV International Panel

    AIDS

    (2007)
  • P.C. Tien

    Management and treatment of hepatitis C virus infection in HIV-infected adults: recommendations from the Veterans Affairs Hepatitis C Resource Center Program and National Hepatitis C Program Office

    Am J Gastroenterol

    (2005)
  • E.E. Mast et al.

    Risk factors for perinatal transmission of hepatitis C virus (HCV) and the natural history of HCV infection acquired in infancy

    J Infect Dis

    (2005)
  • D.L. Thomas et al.

    Perinatal transmission of hepatitis C virus from human immunodeficiency virus type 1-infected mothers

    J Infect Dis

    (1998)
  • T.J. van de Laar et al.

    Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission

    J Infect Dis

    (2007)
  • M. Danta et al.

    Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours

    AIDS

    (2007)
  • M.S. Sulkowski et al.

    Hepatitis C in the HIV-infected person

    Ann Intern Med

    (2003)
  • K.E. Sherman et al.

    Hepatitis C virus prevalence among patients infected with human immunodeficiency virus: a cross-sectional analysis of the US adult AIDS Clinical Trials Group

    Clin Infect Dis

    (2002)
  • J.K. Rockstroh et al.

    Influence of hepatitis C virus infection on HIV-1 disease progression and response to highly active antiretroviral therapy

    J Infect Dis

    (2005)
  • M.E. Eyster et al.

    Natural history of hepatitis C virus infection in multitransfused hemophiliacs: effect of coinfection with human immunodeficiency virus. The Multicenter Hemophilia Cohort Study

    J Acquir Immune Defic Syndr

    (1993)
  • J.J. Goedert et al.

    Increased liver decompensation risk with atypical hepatitis C virus antibody levels

    J Infect Dis

    (2000)
  • D.L. Thomas et al.

    The natural history of hepatitis C virus infection: host, viral, and environmental factors

    JAMA

    (2000)
  • Y. Benhamou et al.

    Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The Multivirc Group

    Hepatology

    (1999)
  • J. Macias et al.

    Effect of antiretroviral drugs on liver fibrosis in HIV-infected patients with chronic hepatitis C: harmful impact of nevirapine

    AIDS

    (2004)
  • S.H. Mehta et al.

    The effect of HAART and HCV infection on the development of hyperglycemia among HIV-infected persons

    J Acquir Immune Defic Syndr

    (2003)
  • N. Qurishi et al.

    Effect of antiretroviral therapy on liver-related mortality in patients with HIV and hepatitis C coinfection

    Lancet

    (2004)
  • S.H. Mehta et al.

    The effect of antiretroviral therapy on liver disease among adults with HIV and hepatitis C coinfection

    Hepatology

    (2005)
  • A. Mocroft et al.

    Is there evidence for an increase in the death rate from liver-related disease in patients with HIV?

    AIDS

    (2005)
  • I. Maida et al.

    Severe liver disease associated with prolonged exposure to antiretroviral drugs

    J Acquir Immune Defic Syndr

    (2006)
  • M.S. Sulkowski et al.

    Hepatic steatosis and antiretroviral drug use among adults coinfected with HIV and hepatitis C virus

    AIDS

    (2005)
  • R.T. Chung et al.

    Immune recovery is associated with persistent rise in hepatitis C virus RNA, infrequent liver test flares, and is not impaired by hepatitis C virus in co-infected subjects

    AIDS

    (2002)
  • P.S. Sullivan et al.

    Effect of hepatitis C infection on progression of HIV disease and early response to initial antiretroviral therapy

    AIDS

    (2006)
  • F.W. Wit et al.

    Incidence of and risk factors for severe hepatotoxicity associated with antiretroviral combination therapy

    J Infect Dis

    (2002)
  • L. Aranzabal et al.

    Influence of liver fibrosis on highly active antiretroviral therapy-associated hepatotoxicity in patients with HIV and hepatitis C virus coinfection

    Clin Infect Dis

    (2005)
  • M.F. Abdelmalek et al.

    Treatment of chronic hepatitis C with interferon with or without ursodeoxycholic acid – a randomized prospective trial

    J Clin Gastroenterol

    (1998)
  • R.K. Sterling et al.

    Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection

    Hepatology

    (2006)
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    Dr. Sulkowski declares that he receives research grants or funding/lecture sponsorships/honoraria for continuing medical education (CME) programs from, or advisor or consultant for Boehringer Ingelheim, Merck, Human Genome Sciences, Valeant, Bristol-Myers-Squibb, Pfizer, Vertex, Roche and Schering, and government grants or research funding (DA-16065 and DA-13806) and General Clinical Research Center at the Johns Hopkins Medical Institutions (MOI-RR00052).

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