Challenges and Priorities in the Management of HIV/HBV and HIV/HCV Coinfection in Resource-Limited Settings

Easterbrook, Philippa; Sands, Anita; Harmancı, Hande

doi:10.1055/s-0032-1316476

Cited by 41 publications

(40 citation statements)

References 44 publications

(59 reference statements)

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“…Recent longitudinal cohort studies have found that coinfection with HBV also can lead to increased rates of progression to acquired immune deficiency syndrome (AIDS)-related outcomes and all-cause mortality 4344. An estimated 5% to 15% of the 34 million HIV-infected individuals worldwide are coinfected with HBV, as a chronic infection 4546. The burden of coinfection is greatest in Southeast Asia and sub-Saharan Africa 6.…”

Section: Epidemiology: Incidence and Prevalencementioning

confidence: 99%

Hepatitis B virus and its sexually transmitted infection – an update

Inoue

Tanaka

2016

MIC

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Epidemiology: incidence and prevalence: About 5% of the world’s population has chronic hepatitis B virus (HBV) infection, and nearly 25% of carriers develop chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). The prevalence of chronic HBV infection in human immunodeficiency virus (HIV)-infected individuals is 5%-15%; HIV/HBV coinfected individuals have a higher level of HBV replication, with higher rates of chronicity, reactivation, occult infection, and HCC than individuals with HBV only. The prevalence of HBV genotype A is significantly higher among men who have sex with men (MSM), compared with the rest of the population. Molecular mechanisms of infection, pathology, and symptomatology: HBV replication begins with entry into the hepatocyte. Sodium taurocholate cotransporting polypeptide was identified in 2012 as the entry receptor of HBV. Although chronic hepatitis B develops slowly, HIV/HBV coinfected individuals show more rapid progression to cirrhosis and HCC. Transmission and protection: The most common sources of HBV infection are body fluids. Hepatitis B (HB) vaccination is recommended for all children and adolescents, and all unvaccinated adults at risk for HBV infection (sexually active individuals such as MSM, individuals with occupational risk, and immunosuppressed individuals). Although HB vaccination can prevent clinical infections (hepatitis), it cannot prevent 100% of subclinical infections. Treatment and curability: The goal of treatment is reducing the risk of complications (cirrhosis and HCC). Pegylated interferon alfa and nucleos(t)ide analogues (NAs) are the current treatments for chronic HBV infection. NAs have improved the outcomes of patients with cirrhosis and HCC, and decreased the incidence of acute liver failure.

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Section: Epidemiology: Incidence and Prevalencementioning

confidence: 99%

Hepatitis B virus and its sexually transmitted infection – an update

Inoue

Tanaka

2016

MIC

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“…1,2 Worldwide, an estimated 31·4–35·9 million people have HIV/AIDS, 350–400 million people have HBV, and 150–170 million have HCV. 3–5 These viruses share routes of transmission and many people with HIV are co-infected with HBV and HCV, especially in some populations such as injection drug users and men who have sex with men. 6–8 The prevalence of HBV co-infection ranges from 5% to 20% and HCV co-infection ranges from 5% to 15% in resource-limited regions.…”

Section: Introductionmentioning

confidence: 99%

“…6–8 The prevalence of HBV co-infection ranges from 5% to 20% and HCV co-infection ranges from 5% to 15% in resource-limited regions. 3 In New York City, the prevalence of HIV and HBV co-infection is 4·5%, that of HIV and HCV co-infection is 25·0%, and that of triple infection (HIV, HBV, and HCV) is 1·6%. 9 The transmission routes and epidemiology of HBV and HCV in people with HIV differ between low-income and high-income countries.…”

Section: Introductionmentioning

confidence: 99%

HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010–12: a retrospective observational cohort study

Zhang

Zhu

et al. 2014

The Lancet Infectious Diseases

115

116

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Summary Background Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China. Methods We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010–11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care. Findings 33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53–2·37) and HCV co-infection (1·46, 1·25–1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89–1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02–1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80–1·10) or HCV co-infection (1·10, 0·97–1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16–1·62) and HCV co-infection (1·30, 1·17–1·45), but not HBV co-infection (0·93, 0·82–1·05), than among those with HIV only. Interpretation Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression. Funding The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.

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“…As HIV-infected persons continue to live longer due to increased uptake of antiretroviral therapy (ART), liver disease has emerged as a leading cause of morbidity and mortality in HIV-infected persons coinfected with HBV or HCV [9–14]. Two recent complementary systematic reviews and meta-analyses have provided updated regional estimates of HIV–HBV and HIV–HCV coinfection across five different population groups [15 ▪▪ ,16 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of viral hepatitis

Easterbrook

Roberts²,

Sands³

et al. 2017

Current Opinion in HIV and AIDS

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Purpose of reviewChronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and HIV–HBV and HCV coinfection are major causes of chronic liver disease worldwide. Testing and diagnosis is the gateway for access to both treatment and prevention services, but there remains a large burden of undiagnosed infection globally. We review the global epidemiology, key challenges in the current hepatitis testing response, new tools to support the hepatitis global response (2016–2020 Global Hepatitis Health Sector strategy, and 2017 WHO guidelines on hepatitis testing) and future directions and innovations in hepatitis diagnostics.Recent findingsKey challenges in the current hepatitis testing response include lack of quality-assured serological and low-cost virological in-vitro diagnostics, limited facilities for testing, inadequate data to guide country-specific hepatitis testing approaches, stigmatization of those with or at risk of viral hepatitis and lack of guidelines on hepatitis testing for resource-limited settings. The new Global Hepatitis Health Sector strategy sets out goals for elimination of viral hepatitis as a public health threat by 2030 and gives outcome targets for reductions in new infections and mortality, as well as service delivery targets that include testing, diagnosis and treatment. The 2017 WHO hepatitis testing guidelines for adults, adolescents and children in low-income and middle-income countries outline the public health approach to strengthen and expand current testing practices for viral hepatitis and addresses who to test (testing approaches), which serological and virological assays to use (testing strategies) as well as interventions to promote linkage to prevention and care.SummaryFuture directions and innovations in hepatitis testing include strategies to improve access such as through use of existing facility and community-based testing opportunities for hepatitis testing, near-patient or point-of-care assays for virological markers (nucleic acid testing and HCV core antigen), dried blood spot specimens used with different serological and nucleic acid test assays, multiplex and multi-disease platforms to enable testing for multiple analytes/pathogens and potential self-testing for viral hepatitis.

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Challenges and Priorities in the Management of HIV/HBV and HIV/HCV Coinfection in Resource-Limited Settings

Cited by 41 publications

References 44 publications

Hepatitis B virus and its sexually transmitted infection – an update

Hepatitis B virus and its sexually transmitted infection – an update

HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010–12: a retrospective observational cohort study

Diagnosis of viral hepatitis

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