Hepatitis C virus infection in HIV-infected patients

Due to shared routes of acquisition, hepatitis C virus (HCV) infection is common in HIV-infected persons. Because the lives of HIV-infected persons have been extended by the use of effective antiretroviral therapies, HCV-related morbidity and mortality have emerged as major health problems. Coinfection with HIV appears to adversely affect all stages of hepatitis C infection, leading to increased viral persistence following acute infection, higher levels of viremia, and accelerated progression of HCVrelated liver disease. In addition, hepatitis C may impact the course and management of HIV infection, increasing the incidence of hepatotoxicity caused by antiretroviral medications. The medical management of hepatitis C in HIV-infected persons remains complex, due largely to the paucity of published clinical trials, potential drug-drug interactions, and the presence of significant comorbid conditions. Nonetheless, in light of an accelerated HCV disease course, the National Institutes of Health Consensus Development Conference Statement (2002) recommends that HIV-infected patients be considered for HCV treatment. Further research is urgently needed on the management of hepatitis C in HIV-infected patients.     

Hepatitis B virus treatment in HIV-infected patients

Hepatitis B virus (HBV) infection is common in HIV-infected persons and is associated with increased risk of liver-related morbidity and mortality. Agents available to treat HBV infection in coinfected patients include lamivudine, entecavir, emtricitabine, adefovir, peginterferon alfa, and the recently approved telbivudine. Treatment decisions should take into account a number of factors, including antiretroviral therapy status, HBV genotype, prior experience of lamivudine, and the need to avoid drug resistance in both HIV- and HBV-infected persons. This article summarizes a presentation on treatment and management of HBV infection in HIV-infected patients made by Chloe L. Thio, MD, at the 9th Annual Ryan White CARE Act Update in Washington, DC. The original presentation is available as a Webcast at www.iasusa.org.     

Hepatitis B virus infection in children

Hepatitis B can develop in less than 5% of neonates of infected mothers, despite neonatal serovaccination. Most children will develop a chronic hepatitis. Most children are in an immune-tolerant or in an inactive phase. Interferon is the treatment of choice, in the rare cases where it is necessary.     

Hepatitis B virus infection in Indonesia

Approximately 240 million people are chronically infected with hepatitis B virus(HBV),75% of whom reside in Asia. Approximately 600000 of infected patients die each year due to HBV-related diseases or hepatocellular carcinoma(HCC). The endemicity of hepatitis surface antigen in Indonesia is intermediate to high with a geographical difference. The risk of HBV infection is high in hemodialysis(HD) patients,men having sex with men,and health care workers. Occult HBV infection has been detected in various groups such as blood donors,HD patients,and HIVinfected individuals and children. The most common HBV subgenotype in Indonesia is B3 followed by C1. Various novel subgenotypes of HBV have been identified throughout Indonesia,with the novel HBV subgenotypes C6-C16 and D6 being successfully isolated. Although a number of HBV subgenotypes have been discovered in Indonesia,genotyperelated pathogenicity has not yet been elucidated in detail. Therefore,genotype-related differences in the prognosis of liver disease and their effects on treatments need to be determined. A previous study conducted in Indonesia revealed that hepatic steatosis was associated with disease progression. Pre-S2 mutations and mutations at C1638 T and T1753 V in HBV/B3 have been associated with advanced liver diseases including HCC. However,drug resistance to lamivudine,which is prominent in Indonesia,remains obscure. Although the number of studies on HBV in Indonesia has been increasing,adequate databases on HBV infection are limited. We herein provided an overview of the epidemiology and clinical characteristics of HBV infection in Indonesia.     

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据2004年的流行病学调查数据显示,全球大约已有3.5亿乙型肝炎病毒(HBV)感染者,而在我国,HBV感染问题已经备受重视。尽管大多数HBV感染者不会发展为具有临床意义的肝脏疾病,仍有15%~40%的患者将最终发生肝硬化、肝功能衰竭或肝细胞癌等严重的并发症[1]。在肾病领域,由于肾衰竭而接受血液透析的患者,发生HBV感染及各种并发症的风险较普通人群更高。因此,如何积极控制HBV在血液透析中的传播并对患者进行有效的治疗已成为肾脏内科医师面临的一个巨大挑战。本文将围绕这一临床问题,结合2007年美国肝病研究学会(AASLD)乙肝防治指南作一简…     

隐匿性乙型肝炎病毒感染

隐匿性HBV感染可定义为病毒基因在HBsAg阴性个体的肝组织中（有些也存在于血清中）长期持续存在。这种特殊慢性病毒感染估计在上世纪80年代初就存在,然而在最近10年里才得到很好的认识。高灵敏分子生物学技术的出现使得认识这种感染病毒成为可能,并揭示其与许多临床疾病可能存在联系。     

Hepatitis B virus infection in dialysis patients

Hepatitis B virus (HBV) infection remains a major issue among dialysis patients. It is associated with a high risk of hepatic complication. The liver disease runs a unique clinical course in dialysis patients, as it can progress with modest hepatic inflammation and prominent fibrosis. The conventional cut-off level of serum alanine aminotransferase (ALT) for commencing antiviral therapy may prove too high and inappropriate for dialysis patients, and liver biopsy appears to be the only definitive means to establish the activity of liver disease in dialysis patients. Liver biopsy should be considered in patients with a serum ALT level that is persistently greater than 30 IU/L, or 0.75-fold the upper limit of the normal level, and/or other clinical and laboratory findings that suggest active liver disease. For antiviral treatment, preliminary reports have shown that lamivudine is effective and well tolerated in dialysis patients. However, the long-term efficacy of lamivudine and its optimal effective dose in dialysis patients remain unknown. The prevention of nosocomial transmission among dialysis patients is also important. Universal precaution measures should be strictly observed and the segregation of hepatitis B surface antigen-positive hemodialysis patients should be considered. For HBV non-immune patients, the importance of HBV vaccination should not be overemphasized. Until a new generation of highly immunogenic vaccines that are proven to be safe and effective in patients with end-stage renal disease becomes available, early vaccination before the development of end-stage renal failure remains the best way to secure immunological protection against HBV infection in dialysis patients.     

Hepatitis B virus infection in immigrant populations

Hepatitis B virus (HBV) is the most common cause of hepatitis worldwide, with nearly 350 million people chronically infected and 600000 deaths per year due to acute liver failure occurring during acute hepatitis or, more frequently, in HBV-related liver cirrhosis or hepatocellular carcinoma. Ongoing immigration from countries with a high HBV endemicity to those with a low HBV endemicity warrants particular attention to prevent the spread of HBV infection to the native population. This review article analyzes the epidemiology and virological and clinical characteristics of HBV infection in immigrant populations and in their host countries, and suggests prophylactic measures to prevent the spread of this infection. Among the immigrants from different geographical areas, those from South East Asia and sub-Saharan Africa show the highest prevalences of hepatitis B surface antigen (HBsAg) carriers, in accordance with the high endemicity of the countries of origin. The molecular characteristics of HBV infection in immigrants reflect those of the geographical areas of origin: HBV genotype A and D predominate in immigrants from Eastern Europe, B and C in those from Asia and genotype E in those from Africa. The literature data on the clinical course and treatment of HBsAg-positive immigrants are scanty. The management of HBV infection in immigrant populations is difficult and requires expert personnel and dedicated structures for their assistance. The social services, voluntary operators and cultural mediators are essential to achieve optimized psychological and clinical intervention.     

Hepatitis B virus infection in Thai children

We studied hepatitis B virus (HBV) transmission among 7416 Thai children from 148 schools in Kamphaeng Phet province, a rural part of northern Thailand. Their age ranged from 2 to 16 years (median 9 years). Between May 1991 and June 1992, 61 of 2593 (2.4%) in the cohort of susceptible children acquired anti-HBc immunoglobulin. Forty-seven of the 148 schools had children who acquired anti-HBc. School seroconversion rates to anti-HBc varied from 0% to 23%. There was no correlation between percent of carriers in schools and percent of anti-HBc acquisition. Of the 61 children who acquired anti-HBc, eight (13%) became HBsAg carriers but only two were symptomatic, for a clinical to subclinical infection ration of 1 : 30. One of the two symptomatic children became an HBsAg carrier. Three (38%) of the eight who were persistently antigenemic developed antibody to hepatitis B virus e antigen. Males were 2.5 times (95% CI 1.4-4.3) more likely to acquire anti-HBc than females. Risk factors for acquisition of HBc in Thailand over a 9-month period were examined in a subset of 2412 susceptible children and later in a case-control study of 22 children who acquired anti-HBc and 59 age and sex-matched controls. Risks for acquiring anti-HBc were male gender and a history of bleeding gums. In comparing this study to an earlier pilot study among 9848 children from the same area in Thailand, the yearly antibody acquisition rate to anti-HBc among Thai children dropped from 5.7% in 1989 to 2.4% in 1992. A random sample of children in the pilot study showed that 16% were HBsAg positive and 27% had anti-HBc at the beginning of the study. 34% had markers for either anti-HBc or HBsAg. 12% were repeatedly positive for HBsAg a year later.     

Hepatitis B virus and HIV infection

Approximately 5 to 10% of human immunodeficiency virus- (HIV-) infected persons worldwide have chronic hepatitis B virus (HBV). The management of these patients merits special attention. They experience a faster progression to cirrhosis and more frequent liver-related death than HBV-monoinfected individuals. For this reason, therapy for both HIV and HBV is a priority in most cases. Some antivirals (i.e., tenofovir, lamivudine, emtricitabine) are active against both viruses and should be part of the antiretroviral treatment choice. However, drugs such as entecavir, telbivudine, or adefovir are active against HBV and may display some residual activity against HIV, occasionally leading to the selection of resistance mutations in the HIV polymerase, as is clearly shown with entecavir. Thus, they should be used only in the context of potent antiretroviral treatment. In this review, the authors will provide updated information on the natural history of HIV/HBV coinfected patients, when and which drugs should be used in treatment, and the concern about selection of drug resistance and vaccine escape mutants.     

Hepatitis B virus infection and pregnancy

Pregnancy only mildly affects that natural progression of acute and chronic infection by the hepatitis B virus (HBV) but it does bring to light three important questions. Mother to child (vertical) transmission risk is best prevented by mandatory HBs antigen testing in all pregnant women in their second trimester and by systemic serovaccination of newborns of infected mothers. In mothers with high viral load, vertical infection in utero could be prevented by lamivudine, telbivudine or tenofovir treatment. Invasive obstetric or gynecological procedures (such as amniocentesis, forceps, etc.) do not seem to increase the risk of vertical infection. Breastfeeding is not contraindicated in maternal HBV infection after serovaccination of the newborn. This holds true for mothers on active treatment with tenofovir which is not absorbed into breast milk. When it comes to managing active antiviral treatment, in absence of virosuppression with lamivudine, tenofovir remains a logical step-up treatment; in absence of virosuppression with adefovir, tenofovir also remains a logical step-up choice as do tenofovir/emtricitabine combinations or lamivudine in absence of preexisting resistance which may have been induced during combination treatment of adefovir and lamivudine. In cases of effective virosuppression with treatment by analogues, lamivudine should be continued and entecavir should eventually be replaced by lamivudine, telbivudine or tenofovir; adefovir should be replaced by tenofovir or lamivudine in absence of resistance (which would require tenofovir therapy) or adefovir which would restrict lamivudine therapy.     

Human papillomavirus infection in HIV-infected persons

Rates of cervical and anal human papillomavirus (HPV) infection and abnormal cytology are high in HIV-infected women, as are rates of anal HPV infection and abnormal cytology in HIV-infected men who have sex with men (MSM). Available evidence indicates that the incidence of anal cancer in HIV-infected MSM has increased in association with prolonged life expectancy achieved with antiretroviral therapy. Routine screening for cervical neoplasia is recommended for HIV-infected women. Routine screening is not yet universally recommended for anal neoplasia, although it should be considered for at-risk patients, particularly given recent improvements in local treatments. A preventive vaccine against cervical HPV infection is approved for use in young women before onset of sexual activity and acquisition of HPV infection. Its potential benefit in preventing anal infection in women and men has yet to be determined, and its potential utility in those with HIV infection remains unknown. This article summarizes a presentation on HPV infection in HIV-infected patients made by Joel Palefsky, MD, at an International AIDS Society-USA Continuing Medical Education course in Chicago in May 2007. The original presentation is available as a Webcast at www.iasusa.org.     

Hepatitis B virus infection in porphyria cutanea tarda

Serum markers of hepatitis B virus (HBV) infection were determined in 82 patients with porphyria cutanea tarda (PCT). Pathogenetic factors (alcohol, thalassemia minor, drugs) and clinical and histologic findings of PCT were taken into account. The prevalence of HBV infection was very high (70.7%). Hepatitis B surface antigen (HBsAg) was positive in 14 patients (17%). Eight patients had HBV infection as the only documented acquired factor. The clinical picture and histologic findings were aggravated by HBV infection; primary hepatic carcinoma occurred in four patients with HBV infection. Liver siderosis was histologically documented in 82.6% of cases, serum ferritin was pathologically increased in 91%, confirming the role of iron overload in PCT. A correlation (p less than 0.02; chi-squared method) was found between increased serum ferritin levels and HBV infection, suggesting a possible relationship between liver siderosis and HBV clearance. HBV infection appears to be a relevant additional factor in the pathogenesis of PCT liver disease.     

Hepatitis B virus infection: current status

Hepatitis B virus currently infects more than 400 million people worldwide. Despite the availability of hepatitis B vaccine, the overall prevalence of hepatitis B virus infection has declined little in recent years. Hepatitis B virus causes liver injury by an immune response against the virus-infected liver cells and is not directly cytopathic, although immunosuppression appears to enhance replication and lead to direct cytotoxicity. The interplay of the host immune response and the virus’s ability to replicate is a prime determinant of the likelihood of liver injury, its intensity, and progression to cirrhosis. A series of stages evolve in the life cycle of each patient’s infection, with associated decreases in viral load at each successive stage. Viral mutations in the polymerase or the core gene affect replication and may enhance liver injury. Recently, genotypes have been identified that are linked to clinical outcomes, drug responses, and mutations. Four drugs (interferon alpha, lamivudine, adefovir, and entecavir) have been approved by the US Food and Drug Administration for treatment of hepatitis B virus; they effectively decrease replication and reduce inflammation and fibrosis. Treatment of hepatitis B virus in complex situations such as co-infection with human immunodeficiency virus or immunosuppressive therapy remains challenging. The use of hepatitis B vaccine has been shown to reduce the incidence of new infection in many regions. A decline in the prevalence of hepatitis B infection worldwide will require changes in high-risk behavior and the wider use of vaccination.     

Hepatitis B virus infection in two Gambian villages

The prevalence of hepatitis B virus infection was markedly different in two neighbouring Gambian villages. 62% of children in Manduar aged 2-4 years were infected whereas in Keneba, the other village, only 27% of this age-group were infected. However, in both villages few infants were infected--none under 6 months of age and only 2 of 58 between the ages of 6 and 12 months. Carriage of hepatitis B surface antigen (HBsAg) was high, reaching a peak of 36% in the 5-9 age-group in Manduar and 17.6% in the 2-4 age-group in Keneba. 86% of all the children under the age of five who were HBsAg-positive also carried hepatitis B e antigen (HBeAg). This proportion fell to 17.6% for children aged 10-14 years and to 12.9% for mothers. Infection clustered in families, transmission from sib to sib being of major importance. The chances of a child being an HBsAg carrier were approximately 42% if an elder sib carried the antigen, 27% if either mother or father was a carrier, and 15% if neither mother or father was a carrier. There were 4 HBeAg-positive mothers who were highly infectious, since 10 of 11 of their children became HBsAg carriers. Carriage of surface antigen lasted many years; 63% of those carrying the antigen in 1972 were still positive in late 1980. 4 cases of primary hepatocellular carcinoma out of 672 adults have been diagnosed in the past five years. All 4 were in HBsAg carriers.     

Hepatitis B virus infection and renal transplantation

Although the prevalence of chronic hepatitis B virus (HBV) infection has declined in renal transplant recipients (RTRs), it remains a relevant clinical problem with high morbidity and mortality in long-term follow up. A thorough evaluation, including liver biopsy as well as assessment of HBV replication in serum (i.e. hepatitis B e antigen and/or HBV DNA) is required before transplantation. Interferon should not be used in this setting because of low efficacy and precipitation on acute allograft rejection. ...     

Hepatitis B virus infection and alcohol consumption

Hepatocellular carcinoma(HCC) is the most common type of primary liver cancer, and the second most common cause of cancer deaths worldwide. The top three causes of HCC are hepatitis B virus(HBV),hepatitis C virus(HCV), and alcoholic liver disease. Owing to recent advances in direct-acting antiviral agents, HCV can now be eradicated in almost all patients. HBV infection and alcoholic liver disease are expected, therefore, to become the leading causes of HCC in the future. However, the association between alcohol consumption and chronic hepatitis B in the progression of liver disease is less well understood than with chronic hepatitis C. The mechanisms underlying the complex interaction between HBV and alcohol are not fully understood, and enhanced viral replication, increased oxidative stress and a weakened immune response could each play an important role in the development of HCC. It remains controversial whether HBV and alcohol synergistically increase the incidence of HCC. Herein, we review the currently available literature regarding the interaction of HBV infection and alcohol consumption on disease progression.