Viral hepatitis and HIV coinfection

HBV and HCV infections are frequent in HIV patients and often contribute significantly to mortality and morbidity. There is no evidence that either HCV or HBV affects HIV disease progression. By contrast, HIV increases HBV and HCV viral replication and leads to higher chronicity rates. It also increases mother-to-child and sexual HCV transmission. HIV speeds the course of HCV and HBV liver disease progression, resulting in accelerated liver fibrosis progression and increased rates of liver decompensation, cirrhosis and hepatocellular carcinoma. Coinfected patients are more likely to have other fibrosis cofactors, such as high alcohol consumption and steatosis. All HIV-infected patients should undergo regular screening for HCV and HBV, using a real-time PCR detection system for HCV RNA and HBV DNA, when possible. Liver damage should be evaluated using liver biopsy or non-invasive methods, such as serum fibrosis marker assays and tissue elastography. HBV and HCV increase HIV drug toxicity. Antiretroviral therapy (ART) has a positive effect on HCV and HBV disease. Didanosine, stavudine and zidovudine should be avoided in HIV treatment in the case of HCV combination therapy with pegylated interferon and ribavirin. Sustained virological response (SVR) is lower in coinfected patients compared with monoinfected patients. Every effort, however, should be made to maintain high-dose therapy, which results in improved SVR. HBV treatment is mainly based on nucleoside/nucleotide analogues. Liver transplantation can be performed in coinfected patients with decompensated cirrhosis. Hepatitis prevention by vaccination against HBV and HAV should be widely considered in the care of HIV-infected patients.