Coinfection and Superinfection of Hepatitis B Virus in Patients Infected with Human Immunodeficiency Virus: No Evidence of Faster Progression to AIDS

Abstract

The influence of hepatitis B virus (HBV) on the natural history of human immunodeficiency virus (HIV) infection was evaluated in a prospective study of 347 HIV-positive, AIDS-free individuals infected through injecting drug use and sex and with known seroconversion dates. End points were CD4+ cell count < 200 x 10(6) cell/L and AIDS diagnosis. At entry, 229 had seromarkers to HBV; during the study, 107 had a CD4+ cell count < 200 x 10(6) cells/L and 66 developed AIDS. HBsAg chronic carriers, HBV infection-free subjects and those with baseline evidence of prior HBV infection did not differ in rates of progression to end points. Sexual transmission of HIV was significant predictor of CD4+ cell decline to < 200 x 10(6) cells/l [Hazard ratio (HZ): 1.56, 95% confidence interval (CI): 1.06-2.29, p = 0.0232] and progression to AIDS (HZ: 1.91, CI: 1.17-3.11, p = 0.0091). 15 HIV-positive and HBV infection-free patients had HBV seroconversion. They did not differ from those who remained HBV infection-free in rates of progression to end points, but 40% of them became HBsAg chronic carriers. These results suggest that HBV has no influence on progression of HIV disease, but that patients who have HIV before their HBV infection are more likely to become HBsAg chronic carriers than those who are infected with HBV before HIV.

Reduced Hepatitis B Virus (HBV)-Specific CD4+T-Cell Responses in Human Immunodeficiency Virus Type 1-HBV-Coinfected Individuals Receiving HBV-Active Antiretroviral Therapy

“…We think this is an unlikely explanation for the absence of HBV-specific CD4 ϩ T cells in HIV-1-HBV coinfection, given that robust restoration of CD4 ϩ T cells to other organisms such as cytomegalovirus occurs following ART (3,65). Nevertheless, HIV-1 coinfection impairs the generation of HBV-specific CD4 ϩ T-cell responses and may account for the increased risk of a persistent HBV infection when HBV infection occurs following HIV-1 infection (32,62). Previous studies of chronic lymphocytic choriomeningitis virus infections show that CD4 ϩ T-cell help is essential in maintaining CD8…”

“…Spontaneous flares and HBeAg seroconversion occur in 5% of HBV-monoinfected individuals; however, in the setting of HIV-1-HBV coinfection, spontaneous flares or seroconversion to HBeAg is rare (18). In individuals infected with HIV-1 who subsequently acquire HBV infection, there is an increased risk of persistent chronic infection (32,62). On the other hand, HBV does not appear to have a significant impact on AIDS progression or the rate of CD4 ϩ T-cell loss (41,62).…”

“…In individuals infected with HIV-1 who subsequently acquire HBV infection, there is an increased risk of persistent chronic infection (32,62). On the other hand, HBV does not appear to have a significant impact on AIDS progression or the rate of CD4 ϩ T-cell loss (41,62). Current treatments for HBV include nucleotide and nucleoside reverse transcriptase inhibitors (RTI) that also suppress HIV-1 replication.…”

Contribution of Immune Activation to the Pathogenesis and Transmission of Human Immunodeficiency Virus Type 1 Infection

“…Among the herpesviruses, epidemiological evidence confirms that CMV coinfection is associated with reduced survival (294,312,315). Furthermore, a meta-analysis of studies of acyclovir prophylaxis of HSV infection indicates that prevention of HSV infection or reactivation of HSV latent infection leads to improved survival of persons with HIV-1 infection (164).…”

Favourable evolution of virological and immunological profiles in treated and untreated patients in Italy in the period 1998-2008

“…In addition, different ethnic groups may have different opportunities to access medical care [8]. Other factors, such as hepatitis coinfections and centre of care, may influence patients' immuno-virological outcomes, although previous studies have reported conflicting results, both in the precART and in the cART eras [9][10][11][12][13][14][15]. Social and clinical centre-related factors were found to be associated with the level of adherence to cART in previous studies [13][14][15][16][17].…”