ReviewViral hepatitis and HIV coinfection☆
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
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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).