Epidemiology, clinical manifestations, and diagnosis of hepatitis B in the HIV-infected patient
- Kenneth E Sherman, MD, PhD
Kenneth E Sherman, MD, PhD
- Professor of Medicine
- University of Cincinnati College of Medicine
- Chloe L Thio, MD
Chloe L Thio, MD
- Professor of Medicine
- Johns Hopkins University
The worldwide epidemics of hepatitis B and HIV have led to new understanding of the complicated interactions between these two viruses. Coinfection with HIV has a major impact on the natural history, diagnosis, progression, and morbidity and mortality related to hepatitis B virus (HBV) infection. The presence of chronic hepatitis B can also lead to an increased risk of hepatotoxicity related to the administration of potent antiretroviral therapy (ART).
The epidemiology, clinical manifestations, and diagnosis of hepatitis B in the HIV-infected patient will be reviewed here. Treatment and prevention as well as issues related to hepatitis C and HIV coinfection are discussed separately. (See "Treatment of chronic hepatitis B in the HIV-infected patient" and "Prevention of hepatitis B virus infection in the HIV-infected adult" and "Epidemiology, natural history, and diagnosis of hepatitis C in the HIV-infected patient" and "Evaluation of the HIV-infected patient with chronic hepatitis C virus infection".)
Hepatitis B virus (HBV) and HIV are often diagnosed in the same patient because they share similar routes of transmission. Chronic HBV affects approximately 10 percent of HIV-infected patients worldwide  and a study of 16,248 HIV-infected patients in the United States found the prevalence of chronic HBV was 8 percent among unvaccinated participants .
However, the rates of HIV/HBV coinfection vary according to geographic region and are highest in sub-Saharan Africa and Asia, where most transmission occurs perinatally and horizontally. In developed countries, laboratory markers of prior HBV infection are more common in men who have sex with men (MSM) and injection drug users [2-4].
DIAGNOSIS OF CHRONIC HBV INFECTION
HIV-infected patients should have routine testing for Hepatitis B virus (HBV) infection with hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and hepatitis B surface antibody (anti-HBs) [5,6]. The diagnosis of chronic hepatitis B is made the same way in HIV-infected patients as in HIV-seronegative patients . A detailed discussion on the diagnosis of HBV infection is found elsewhere and is summarized below. (See "Diagnosis of hepatitis B virus infection".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- DIAGNOSIS OF CHRONIC HBV INFECTION
- ISOLATED ANTI-HB CORE ANTIBODY
- Occult HBV
- Immunologic factors
- Virologic factors
- HIV AND NATURAL HISTORY OF HBV INFECTION
- HIV AND LIVER DISEASE PROGRESSION
- EFFECT OF HIV ON LIVER-RELATED MORTALITY
- EFFECT OF HBV ON HIV PROGRESSION
- EFFECT OF HBV ON ALL CAUSE MORTALITY
- HBV AND IMMUNE RECONSTITUTION
- HBV AND RISK OF DRUG INDUCED HEPATOTOXICITY
- SUMMARY AND RECOMMENDATIONS