Approximately 10% of the HIV-infected population worldwide is infected with hepatitis B

This figure may approach 20% in Southeast Asia, and 5% in North America and Western Europe.

Worldwide prevalence of HBV co-infection could be estimated to be 5%–10% in persons living with HIV infection.

In the U.S., Western Europe and Australia, the prevalence of chronic hepatitis B was reported to be 5%-14% among HIV-positive individuals.

How is HIV/Hepatitis B co-infection transmitted?

Due to the shared transmission method of both HIV and hepatitis B, co-infection is not entirely unsurprising. Both viruses can be transmitted through –

  • Childbirth from mother to baby

  • Unsafe medical procedures or injection practices (sharing of needles)

  • Unscreened blood transfusions

  • Unprotected sex

Management of Hepatitis B and C in the HIV-infected population

Conditions associated with hepatitis B and C are currently among the leading causes of hospital admission and death in the HIV-infected population. Therefore, the adequate management of hepatitis B and C is now being considered a priority in HIV-coinfected patients.

 

There are three main reasons for considering HBV therapy as a priority in HBV/HIV coinfected patients

  • Liver Disease

    First, liver disease may progress more rapidly in those patients co-infected with HBV/HIV and could lead to serious liver disease complications such as cirrhosis and liver cancer at younger ages.

  • Hepatotoxicity

    Second, there is a higher risk of developing hepatotoxicity following the initiation of antiretroviral therapy in HIV patients co-infected with HBV than in patients infected with HIV alone.

  • CD4 T-cell count

    Hepatitis B in HIV-infected patients is associated with a lower CD4 T-cell count than HIV-monoinfected people.

Hepatitis B and HIV disease progression

There is no evidence that hepatitis B affects HIV disease progression or that hepatitis B alters the response of HIV to antiretroviral therapy (ART).

However, starting ART may be associated with an increased risk of liver inflammation in coinfected individuals, as evidenced by ALT (Alanine Aminotransferase) flares or rising liver enzymes.

This may reflect both an immune response against Hepatitis B and/or drug toxicity.

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