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[Chronic hepatitis B and C in HIV-infected patients]
M Opravil1, R Hunziker, R Lüthy
1Abteilungen für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich.
Insights
HIV patients frequently have co-infections with hepatitis B virus (HBV) and hepatitis C virus (HCV). Intravenous drug use is linked to high HBV/HCV co-infection rates, strongly associated with chronic hepatitis development.
Area of Science:
- Hepatology
- Infectious Diseases
- HIV Medicine
Background:
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) are significant co-infections in individuals with human immunodeficiency virus (HIV).
- Understanding the prevalence of these co-infections across different risk groups is crucial for managing liver disease in HIV patients.
Purpose of the Study:
- To investigate the prevalence of HBV and HCV co-infections among HIV-infected patients.
- To determine the frequency of chronic hepatitis in relation to risk groups and serological status.
- To analyze the association between specific co-infections and the development of chronic liver disease.
Main Methods:
- Retrospective analysis of HIV-infected patients from the Swiss HIV Cohort Study in Zurich.
- Evaluation of available hepatitis B and C serology and alanine aminotransferase (ALT) results.
- Categorization of patients based on risk factors: intravenous drug use, homosexual, and heterosexual transmission.
Main Results:
- Among 279 patients, 47% had co-infection with both HBV and HCV, 33% had HBV alone, and 3% had HCV alone.
- Intravenous drug users showed the highest co-infection rate (87% with HBV and HCV), while sexually transmitted HIV infections had low HCV prevalence (3%).
- Chronic hepatitis (ALT elevation > 6 months) was observed in 24% of patients, with significantly higher rates in those with active HBV/HCV co-infection (46%) compared to HBV alone (18%) or HCV alone (36%).
Conclusions:
- HBV is frequently co-transmitted with HIV in sexually acquired infections.
- Nearly all HIV patients infected through intravenous drug use exhibit HBV and HCV co-infection.
- HBV/HCV co-infection is a primary driver of chronic hepatitis with persistent ALT elevation in HIV-infected individuals.
Background And Aim:
This retrospective study examined the prevalence of co-infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) and the frequency of chronic hepatitis in HIV-infected patients with respect to both the different risk groups and the serological results.
Patients And Methods:
All Zurich participants of the Swiss HIV Cohort Study were evaluated who had available results of hepatitis B and C serology and ALT.
Results:
Of the total 279 patients, 52% belonged to the intravenous drug user, 34% to the homosexual, and 11% to the heterosexual risk category. Serologically, previously acquired infection with HBV alone could be demonstrated in 92 (33%), HCV alone in 9 (3%), and both HBV and HCV in 130 (47%) patients. Only 3% of patients with sexually acquired HIV infection had anti-HCV antibodies, whereas co-infection with HBV and HCV was present in 87% of intravenous drug users. Among the 222 patients with previous HBV contact, 25 (11%) had positive HBsAg and 91 (41%) had "anti-HBc alone", both assumed to represent active HBV infection. 66 (24%) of 279 patients had chronic hepatitis with ALT elevation lasting > or = 6 months. Chronic hepatitis was present in 46% of those with active HBV and HCV co-infection, in 36% of those with HCV infection alone and in 18% of those with active HBV infection alone (P < 0.001). Of the 66 cases of chronic hepatitis, 58 were associated with HCV infection, and only 2 cases had no serological signs of active HBV or HCV infection.
Conclusion:
In patients with sexually acquired HIV infection, HBV had frequently been co-transmitted. In contrast, almost all of those infected by means of intravenous drug use had a co-infection with both HBV and HCV. The latter seems to play the strongest role in the development of chronic hepatitis with persistent ALT elevation. A chronic ALT elevation was almost always associated with serologically active HBV or HCV infection.