Hepatitis C and HIV co-infection

HIV accelerates progression of hepatitis C virus (HCV)-related liver disease. There are conflicting data on the effect of HCV on the risk of HIV progression and CD4 response to highly active antiretroviral therapy (HAART). Long-term prospective cohort studies are clearly required to resolve these issues. The optimal management of the co-infected patient is also unclear. For the co-infected patient, the optimal HAART regimen for best immune CD4 recovery and least adverse reactions remains unclear. Unfortunately, current HCV treatment is associated with significant side effects and a considerable proportion of HIV co-infected patients are poor candidates for HCV treatment. Better and more effective treatment for HCV (preferably not based on interferon) is urgently required for this group of patients. Patients with good CD4 cell count and with HCV genotypes 2 and 3 are likely to have a reasonable response to treatment.     

Hepatitis C virus and HIV co-infection: a sleeping giant wakes

Advances in HIV therapy have greatly reduced the incidence of HIV-related complications and mortality, but co-infection with hepatitis C (HCV) virus is becoming more visible. The two infections share transmission routes, with injection drug users and transfusion patients the most commonly infected. Although sexual transmission is less common with HCV, it may be facilitated by an existing HIV infection. Effective HCV treatment strategies are urgently needed for people with HIV because it is leading to notable morbidity and mortality. Trial results of alfa interferon monotherapy are presented. The combination of interferon with Ribavirin also shows promise.     

Hepatitis C and HIV co—infection：a review

Co-infection with hepatitis C virus and human immunodeficiency virus is common in certain populations. Among HCV (+) persons, 10 % are also HIV (+), and among HIV (+) persons, 25 % are also HCV (+). Many studies have shown that in intravenous drug users, co-infection prevalence can be as high as 90-95 %. There is increasing evidence supporting the concept that people infected with HIV have a much more rapid course of their hepatitis C infection. Treatment of co-infection is often challenging because highly active anti-retroviral therapy (HAART) therapy is frequently hepatotoxic, especially in the presence of HCV. The purpose of this review is to describe the effects that HIV has on hepatitis C, the effects that hepatitis C has on HIV, and the treatment options in this challenging population.     

HIV and hepatitis C virus co-infection

Some reports have suggested that drug-induced hepatotoxicity can be associated with antiretroviral therapy in HIV-positive people coinfected with chronic hepatitis C virus (HCV). Several presentations at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) examined this possible interaction. The impact of highly active antiretroviral therapy (HAART) on persons coinfected with HCV was described. There is increasing clinical recognition that HCV can lead to significant liver-related morbidity and mortality among HIV-infected persons.     

Hepatitis B virus infection: co-infection with hepatitis C virus, hepatitis D virus, and human immunodeficiency virus

Hepatitis B virus (HBV) shares routes of transmission, namely exchange of infected body fluids, sharing of contaminated needles, and blood transfusion, with other hepatotropic viruses, such as hepatitis C virus (HCV) and hepatitis D virus (HDV) and with systemic retroviral infections, such as the human immunodeficiency virus (HIV). Thus, many HBV infected patients are co-infected with other viral pathogens. Co-infection appears to increase the risk of progression of liver disease and may have important ramifications on choice of antiviral medication and treatment regimen. This article reviews the current knowledge of co-infection of HBV with HCV, HDV, and HIV.     

HIV and hepatitis C virus co-infection

Since the decline in HIV-related morbidity and mortality after introduction of highly active antiretroviral therapy (HAART) in 1996, liver disease caused by chronic infection with hepatitis C virus (HCV) has become an increasingly important cause of morbidity and mortality among HIV-infected patients infected parenterally with HCV in more developed countries. A third of HIV-infected individuals in Europe and the USA have HCV co-infection. HIV accelerates HCV liver disease especially when HIV-associated immunodeficiency progresses. With the introduction of pegylated interferon in combination with ribavirin, greatly improved treatment options for patients with HIV and HCV co-infection have become available and have led to sustained virological response rates of up to 40%. Furthermore, recent cohort analyses have shown that immune reconstitution induced by HAART can improve the course of hepatitis C leading to a decline in liver-related mortality. However, patients with HCV co-infection are at increased risk of hepatotoxicity from HAART. Owing to the high rates of HIV and HCV co-infection worldwide, new improved treatment strategies and guidelines for the management of co-infection remain a major future goal.     

Hepatitis C virus infection, HIV co-infection, and associated risk among injecting drug users in Togliatti, Russia

The objective of this study was to estimate the prevalence of hepatitis C virus (HCV) infection and co-infection with HIV among injecting drug users (IDUs) in Togliatti City, Russia. Unlinked anonymous cross-sectional survey of IDUs recruited from community settings, with oral fluid sample collection for HCV and HIV antibody (anti-HCV, anti-HIV) testing, was carried out. The anti-HCV prevalence was 87% (357/411), anti-HIV prevalence 56% (234/418), and 93% (214/230) of HIV-positive IDUs were co-infected with HCV. Only 23% (94/411) of those HCV positive self-reported as such. In an adjusted model, increased odds of HCV positivity were associated with needle and syringe, as well as injecting paraphernalia sharing in the last four weeks. IDUs injecting more than once with the same needle also had raised odds. There were no marked associations between HCV positivity and the duration of injecting or age group. Almost all IDUs were HCV positive, and almost all HIV-positive IDUs were HCV co-infected. There is an urgent need to maximize syringe distribution coverage, develop health promotion targeting HCV prevention for IDUs, and improve access among IDUs to treatments for HIV and HCV infection.     

Hepatitis C virus seroprevalence and risk factors among patients with HIV infection

The objective of this study was to evaluate the prevalence and risk factors associated with HCV infection in a group of HIV seropositive patients. We analyzed the medical records of 1,457 patients. All patients were tested for HCV infection by third generation ELISA. Whenever possible, a sample of the positive patients was also tested for HCV by PCR. HCV positive patients were analyzed according to their risk factors for both infections. The prevalence of anti-HCV positive patients was 17.7% (258 patients). Eighty-two (82) of these patients were also tested by PCR and 81 were positive for HCV virus (98%). One hundred fifty-one (58.5%) were intravenous drug users (IDU); 42 (16.3%) were sexual partners of HIV patients; 23 (8.9%) were homosexual males; 12 (4.7%) had received blood transfusion; 61 (17.5%) had promiscuous sexual habits; 14 (5.4%) denied any risk factor; 12 (4.7%) were sexual partners of IDU. Two hundred four patients mentioned only one risk factor. Among them, 28 (10.9%) were sexual partners of HIV-positive patients. Although intravenous drug use was the most important risk factor for co-infection, sexual transmission seemed to contribute to the high HCV seroprevalence in this group of patients.     

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/C virus co-infection in Iran: A seroepidemiological study.

Background/aims: As hepatitis B and C virus have the same transmission routes, dual infection may occur. The aim of this study was to determine the seroprevalence of HCV in HBsAg-positive subjects. Methods: 139 HBsAg-positive subjects were enrolled in the study. Serum samples were tested using ELISA method for anti-HCV antibodies. Chi-square and Fisher's exact tests were used to compare the proportions. Results: There were 68 (48.9%) males and 71 (51.1%) females. The mean age was 41.89+/-11.30 years. One case was excluded because of inadequate blood sampling. Anti-HCV antibody was positive in 17 (12.3%) of the 138 remaining subjects. Seropositivity of HCV was similar between female and male patients (p=0.69). Conclusion: The seroprevalence of co-infection with hepatitis B virus and hepatitis C virus in our study was higher than such reports from some countries (Italy), but was in line with worldwide prevalence (>10%).     

Hepatitis C virus and HIV coinfection

The world-wide prevalence of hepatitis C virus (HCV) is approximately 1%. Being primarily a blood-borne virus, the major risk factors for HCV include the receipt of blood and blood products, as well as intravenous drug use. As a result, many individuals infected with HIV are also infected with HCV. Any effect of coinfection on progression of either HIV or HCV is likely to have a tremendous impact on the mortality and morbidity of these individuals and should be considered when managing coinfected individuals. This review will describe the epidemiology and clinical manifestations of HCV and will consider the evidence for an impact of coinfection on the progression of both viruses.