HIV-HBV Coinfection—Current Challenges for Virologic Monitoring (original) (raw)
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World Journal of Gastroenterology, 2019
Hepatotropic viruses induced hepatitis progresses much faster and causes more liver-related health problems in people co-infected with human immunodeficiency virus (HIV). Although treatment with antiretroviral therapy has extended the life expectancy of people with HIV, liver disease induced by hepatitis B virus (HBV) and hepatitis C virus (HCV) causes significant numbers of non-acquired immune deficiency syndrome (AIDS)-related deaths in coinfected patients. In recent years, new insights into the mechanisms of accelerated fibrosis and liver disease progression in HIV/HCV and HIV/HBV co-infections have been reported. In this paper, we review recent studies examining the natural history and pathogenesis of liver disease in HIV-HCV/HBV co-infection in the era of direct acting antivirals (DAA) and antiretroviral therapy (ART). We also review the novel therapeutics for management of HIV/HCV and HIV/HBV coinfected individuals.
Antiviral Therapy, 2013
Background We investigated changes in biomarkers of liver disease in HIV–HCV-coinfected individuals during successful combination antiretroviral therapy (cART) compared to changes in biomarker levels during untreated HIV infection and to HIV-monoinfected individuals. Methods Non-invasive biomarkers of liver disease (hyaluronic acid [HYA], aspartate aminotransferase-to-platelet ratio index [APRI], Fibrosis-4 [FIB-4] index and cytokeratin-18 [CK-18]) were correlated with liver histology in 49 HIV–HCV-coinfected patients. Changes in biomarkers over time were then assessed longitudinally in HIV–HCV-coinfected patients during successful cART ( n=58), during untreated HIV-infection ( n=59), and in HIV-monoinfected individuals ( n=17). The median follow-up time was 3.4 years on cART. All analyses were conducted before starting HCV treatment. Results Non-invasive biomarkers of liver disease correlated significantly with the histological METAVIR stage ( P<0.002 for all comparisons). The m...
The association of HIV viral load with indirect markers of liver injury
Journal of Viral Hepatitis, 2011
This study assessed the association of HIV RNA with indirect markers of liver injury including FIB-4 index, liver enzymes and platelet counts in a high-risk Hispanic population. The data were derived from a prospective study that included 138 HIV/hepatitis C (HCV) co-infected and 68 HIV-infected participants without hepatitis C or B co-infection (mono-infected). In unadjusted analyses, detectable HIV viral load (vs. undetectable, <400 copies/ml) was associated with a 40% greater odds (OR 1.4, 95% CI: 1.1-1.9, p=0.016) of FIB-4 > 1.45 in the HIV/HCV co-infected group and 70% greater odds of FIB-4 >1.45 (OR 1.7, 95% CI: 1.0-2.8; p=0.046) in the HIV mono-infected group. In multivariable analyses a 1 log 10 increase in HIV RNA was associated with a median increase in FIB-4 of 12% in the HIV/HCV co-infected group and 11% in the HIV mono-infected group (p<0.0001). Among the HIV/HCV co-infected, the elevating effect of HIV RNA on FIB-4 was strongest at low CD4 counts (p=0.0037). Among the HIV mono-infected, the association between HIV RNA and FIB-4 was independent of CD4 cell counts. HIV RNA was associated with alterations in both liver enzymes and platelet counts. HIV antiretroviral therapy was not associated with any measure of liver injury examined. This study suggests that HIV may have direct, injurious effects on the liver and that HIV viral load should be considered when these indirect markers are used to assess liver function.
HBV and HIV co-infection: Impact on liver pathobiology and therapeutic approaches
World Journal of Hepatology, 2015
The consequences of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection on progression of severe liver diseases is a serious public health issue, worldwide. In the co-infection cases, about 90% of HIV-infected population is seropositive for HBV where approximately 5%-40% individuals are chronically infected. In HIV co-infected individuals, liverrelated mortality is estimated over 17 times higher than those with HBV mono-infection. The spectrum of HIVinduced liver diseases includes hepatitis, steatohepatitis, endothelialitis, necrosis, granulomatosis, cirrhosis and carcinoma. Moreover, HIV co-infection significantly alters the natural history of hepatitis B, and therefore complicates the disease management. Though several studies have demonstrated impact of HIV proteins on hepatocyte biology, only a few data is available on interactions between HBV and HIV proteins. Thus, the clinical spectrum as well as the complexity of the co-infection offers challenging fronts to study the underlying molecular mechanisms, and to design effective therapeutic strategies.
Performance of 11 biomarkers for liver fibrosis assessment in HIV/HBV co-infected patients
Journal of Hepatology, 2009
The aim of this study was to compare the performance of 11 biochemical scores to estimate liver fibrosis in HIV/HBV co-infection. Performance was evaluated using the Receiver Operating Characteristics (ROC) curve method. The Kappa index was used to study overall agreement with liver biopsy results. Interpretative algorithms were established by optimizing sensitivity and specificity and the percentage of correctly classified patients. One hundred and eight patients (F0-F1, n = 47; F2, n = 28; F3, n = 17; F4, n = 16) were considered for the evaluation of serum biomarker performance. The AUROCs of the Fibrotest, Hepascore, Fibrometer, and Zeng&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s scores ranged from 0.74 to 0.77 for significant fibrosis (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = F2), from 0.79 to 0.84 for advanced fibrosis (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = F3) and from 0.87 to 0.92 for cirrhosis (F4). Thresholds defined for each stage of fibrosis were close to those previously published for the Fibrotest and Hepascore. Strict concordance with biopsies correctly classified 50% of the patients. Fibrotest, Fibrometer, Hepascore, and Zeng&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s score were the most accurate non-invasive biochemical scores for liver fibrosis assessment in HIV/HBV co-infection. Global performance of biomarkers was not significantly improved by a decision tree combining the results of two biochemical scores.
Research Square (Research Square), 2022
Background: Noninvasive markers of liver brosis have gained central importance in the assessment of patients with liver diseases. Among patients with Hepatitis B and HIV coinfection, the role of these noninvasive serum markers has not been well studied in the Ethiopian setup. Methodology: A hospital-based cross-sectional study was conducted at Tikur Anbessa Hospital ART clinic. Patients with HIV and HBV coinfection were recruited from the clinic, and a second comparison group with HBV mono-infection was recruited from the liver clinic. All patients were on tenofovir-based treatment of hepatitis B. Baseline demographic and laboratory values comparison between the two groups were conducted. For APRI, a cutoff of 0.5 and 1.5 was used to assess brosis; and for FIB4, cutoffs of 1.45 and 3.25 were used as the lower and higher cutoff, respectively. Result: A total of 74 patients were included, of which 24 patients were with HBV/HIV coinfection and 50 were with HBV mono-infection. The median age of participants was 37, and the majority were from Addis Ababa. Prevalence of diabetes and alcohol use was comparable in both groups. The median platelet count among patients with coinfection was 220,000 (IQR 159000-277000), while among the monoinfected patients, it was 166000 (87750-227500). The APRI score among the coinfected patients was 0.4 (0.23-0.59) while it was 0.57 (0.4-1.4) (p= 0.01). The FIB4 was 1.1 (0.69-2.03) among coinfected patients, while it was 1.7 (1-2.9) among monoinfected patients (p=0.01). Using a lower and higher APRI and FIB4 cutoffs, both groups had a statistically nonsigni cant difference. However, the platelet count using a cutoff of 1500000 was signi cantly lower among patients with HBV monoinfection. Conclusion; Our data indicate that patients with HIV/HBV coinfection on treatment had comparable noninvasive liver brosis marker pro les compared to patients with HBV mono-infection on therapy. On the majority of the parameters, there was a trend towards a better pro le among patients with coinfection, which might be explained by early initiation of tenofovir therapy as part of HIV treatment.
Antiviral Therapy, 2013
BackgroundAdvanced liver fibrosis frequently develops in patients with chronic hepatitis C coinfected with HIV. Non-invasive techniques for staging liver fibrosis, such as transient elastometry, may allow both periodic monitoring and examination of large patient populations.MethodsA programme of liver fibrosis assessment using transient elastometry has been ongoing at our institution since 2004. All HIV-HCV-coinfected patients having ≥2 examinations separated by >18 months were included. Liver fibrosis progression (LFP) was defined as an increase in liver stiffness from <9.5 kPa (Metavir F0-F2) to >9.5 kPa (Metavir F3-F4), or an increase >30% in patients with baseline Metavir F3-F4.ResultsA total of 545 HIV-HCV-coinfected patients were analysed (mean age 41 years, 71% male, 81% intravenous drug users, mean body mass index 23.3 kg/m2, 4.2% hepatitis B surface antigen-positive, 8.4% alcohol abuse, mean CD4+T-cell count 519 cells/μl). At baseline, 527 patients were on antir...
BMC infectious diseases, 2018
Co-infection with HIV negatively impacts the progression of chronic hepatitis B virus (HBV) infection, including causing rapid progression to liver fibrosis. Sub-Saharan Africa represents arguably the most important intersection of high endemicity of both chronic hepatitis B virus (HBV) infection and HIV infection. We recruited 46 HBV/HIV-co-infected; 47 HBV-monoinfected; 39 HIV-monoinfected; and 37 HBV/HIV-uninfected patients from Tygerberg Hospital, Cape Town, South Africa. All HIV-infected patients were on antiretroviral therapy for ≥3 months. Liver stiffness measurements were assessed using the Fibroscan (Fibroscan 402, Echosens). Cell-based immunomarkers were measured by flow cytometry. Soluble serum/plasma immunomarkers were measured by Luminex technology and enzyme immunoassays. HIV (COBAS/Ampliprep TaqMan HIV-1) and HBV viral loads (in-house assay) were also performed. HBV/HIV co-infected patients showed significantly higher levels of immune activation %CD8+/HLA-DR+/CD38+ (m...