Viral Hepatitis in HIV Infection  

Oleh:

Koziel, Margaret James ; Peters, Marion G.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 356 no. 14 (Apr. 2007), page 1445.

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Perpustakaan FK Nomor Panggil: N08.K.2007.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

EPATITIS C VIRUS (HCV) AND HEPATITIS B VIRUS (HBV) INFECTIONS ARE common among patients with human immunodeficiency virus (HIV) infec tion because of shared routes of viral transmission. Liver disease due to chronic HBV and HCV infection is becoming a leading cause of death among persons with HIV infection worldwide, and the risk of death related to liver disease is inversely related to the CD4 cell count (Fig. 1).1,2 There is also an increase in the incidence of hepatocellular carcinoma and hepatotoxic effects associated with antiretroviral drugs' in patients with HCV and HBV coinfection.1,3-6 New treatments for both HCV and HBV ; infections have increased the opportunities to manage these infections and poten- I tially prevent complications of liver disease. EPIDEMIOLOGY The prevalence of coinfection with either HCV or HBV varies depending on the patient's risk factors for HIV acquisition? HCV is most efficiently spread through direct exposure to contaminated blood or blood products. Rates of vertical and perinatal transmission are low, although they are increased in the setting of coinfection. Sexual transmission of HCV is inefficient, and the exact risk related to different types of sex ual activity is unknown, although there has been increasing recognition of cases of acute HCV infection associated with unsafe sex practices among men who have sex with men.9 In the United States, HIV and HCV coinfection is most prevalent among patients who have a history of either hemophilia or intravenous drug use. Among these patients, rates of coinfection approach 70 to 95%, as compared with 1 to 12% among men who have sex with men? Since the rate of clearance of HBV varies according to the patient's age, the risk of HIV and HBV coinfection depends on the patient's age at the time of exposure to both viruses. In the United States and Western Europe, HBV is typically acquired during sexual activity in adolescence or early adulthood. Although there is a high rate of spontaneous clearance of HBV (>90%) in immunocompetent adults, chronic infection develops in 20% of adults with HIV infection after exposure to HBV.1O The overall prevalence of chronic HBV infection among HIV-positive persons in the United States and Western Europe is less than 10%, and it is highest among men who have sex with men and among intravenous drug users. In areas where vertical and perinatal transmission ofHBV is common, such as Asia and sub-Saharan Africa, chronic HBV infection develops in more than 90% of infants exposed to HBV.u Thus, the prevalence of HBV infection among HIV-infected persons varies markedly, from 5 to 10% in the United States12,13 to 20 to 30% in Asia and parts of sub-Saharan Africa.14,15

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