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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Hepatitis B with HIV coinfection

Introduction

For main chapter on AIDS, click here

For main chapter on HIV, click here

For main chapter on Hepatitis B, click here

Overview

Overview

Overview

Coinfection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) is common due to shared routes of transmission. The impact of coinfection 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]

References

  1. ↑ 1.0 1.1 Hoffmann CJ, Thio CL (2007). “Clinical implications of HIV and hepatitis B coinfection 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)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

Pathophysiology

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References

Causes

Causes

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References

Differentiating HIV coinfection with hepatitis b from other Diseases

Differentiating HIV coinfection with hepatitis b from other Diseases

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References

Epidemiology and Demographics

Epidemiology and Demographics

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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 coinfection is around 5-7% among HIV-infected individuals.[1] 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 coinfection rates are 10-20%.[2][3][4]

References

  1. ↑ Alter MJ (2006). “Epidemiology of viral hepatitis and HIV coinfection”. J. Hepatol. 44 (1 Suppl): S6–9. doi:10.1016/j.jhep.2005.11.004. PMID 16352363. Retrieved 2012-03-29.
  2. ↑ 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)
  3. ↑ 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)
  4. ↑ 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)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Risk Factors

Risk Factors

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References

Screening

Screening

Screening

For HIV infected individuals with chronic HBV, additional screening for coinfection 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. [1]

References

  1. ↑ 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)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

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Natural History

The rate of progression and complications from viral hepatitis are accelerated in patients with HIV coinfection.[1][2] After acquiring HBV infection, HIV infected individuals are 6 times more likely to develop chronic hepatitis B than HIV negative individuals.[3][4][5] 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.[6][7][8] 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.[9][10]

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.[6][11]

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.[12] If reactivation occurs, resuming an agent that is active against HBV is required.

HIV-HBV coinfected men are greater than 17 times more likely to die of liver related causes compared to those mono-infected with HBV.[13] For individuals on ART, coinfection with chronic hepatitis B increases the risk of hepatotoxicity from ART three-fold to five-fold.[14][15][16]

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.[17]

References

  1. ↑ 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)
  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)
  3. ↑ 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)
  4. ↑ 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)
  5. ↑ 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)
  6. ↑ 6.0 6.1 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)
  7. ↑ 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)
  8. ↑ 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)
  9. ↑ 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)
  10. ↑ 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)
  11. ↑ 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)
  12. ↑ 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 coinfected 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)
  13. ↑ 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)
  14. ↑ 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)
  15. ↑ 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)
  16. ↑ 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.
  17. ↑ 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)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnosis

Diagnosis

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Treatment

Medical Therapy | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

Related Chapters

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