Hepatitis B and human immunodeficiency virus coinfection

Area of Science:

• Infectious Diseases
• Hepatology
• Virology

Background:

• Hepatitis B virus (HBV) coinfection is prevalent in individuals with human immunodeficiency virus (HIV), affecting approximately 10% globally.
• Liver disease has become a primary cause of illness and death in HIV-infected individuals, surpassing traditional AIDS-related opportunistic infections due to effective antiretroviral therapy.
• HIV infection significantly worsens the natural course of chronic hepatitis B, leading to higher viral loads, increased cirrhosis, and a greater risk of liver cancer.

Purpose of the Study:

• To review the impact of HIV on the natural history and progression of chronic hepatitis B.
• To discuss the complexities in managing coinfection, including challenges with antiviral therapies and drug resistance.
• To highlight the need for further research into optimal treatment strategies and understanding disease mechanisms in coinfected individuals.

Main Methods:

• Literature review and synthesis of existing data on HIV-HBV coinfection.
• Analysis of the impact of HIV on HBV pathogenesis and clinical outcomes.
• Examination of current treatment guidelines and challenges in managing coinfected patients.

Main Results:

• HIV-1 infection significantly worsens the course of chronic HBV infection.
• Coinfected individuals exhibit increased rates of persistent HBV infection, higher HBV DNA levels, and reduced rates of hepatitis B e antigen loss.
• There is an elevated risk of cirrhosis, liver-related mortality, and hepatocellular carcinoma in coinfected individuals, even at lower CD4+ T cell counts.

Conclusions:

• Management of HBV in HIV-positive individuals is complex due to drug interactions and the rapid emergence of drug-resistant HBV strains.
• Current treatment approaches often extrapolate data from HBV monoinfected populations, highlighting a critical need for specific research in coinfected individuals.
• Further investigation is essential to elucidate the mechanisms driving accelerated liver disease and to establish optimal treatment goals for HIV-HBV coinfection.