Approximately 10% of the HIV-infected population worldwide is infected with hepatitis B. This figure may approach 20% in Southeast Asia, and 5% in North America and Western Europe. Worldwide prevalence of HBV coinfection could be estimated to be 5%–10% in persons living with HIV infection.
In the U.S., Western Europe and Australia, the prevalence of chronic hepatitis B was reported to be 5%-14% among HIV-positive individuals.
Since both HIV and the hepatitis B virus share similar transmission routes, it is not surprising that there is a high frequency of coinfection. Both viruses can be transmitted from mother-to-baby during childbirth (due to blood exchange from mother to baby), through unsafe medical and injection practices, and unscreened blood transfusions. Sexual activity and/or injection drug use are other common routes of transmission of the hepatitis B virus among those also infected with HIV.
While highly active antiretroviral therapy (HAART) has dramatically improved the lives of those with HIV, the consequences of associated illnesses such as hepatitis B coinfections have become more relevant.
Conditions associated with hepatitis B and C are currently among the leading causes of hospital admission and death in the HIV-infected population. Therefore, the adequate management of hepatitis B and C is now being considered a priority in HIV-coinfected patients.
There are three main reasons for considering HBV therapy as a priority in HBV/HIV coinfected patients:
- First, liver disease may progress more rapidly in those patients co-infected with HBV/HIV and could lead to serious liver disease complications such as cirrhosis and liver cancer at younger ages.
- Second, there is a higher risk of developing hepatotoxicity following the initiation of antiretroviral therapy in HIV patients co-infected with HBV than in patients infected with HIV alone.
- Hepatitis B in HIV-infected patients is associated with a lower CD4 T-cell count than HIV-monoinfected people.
There is no evidence that hepatitis B affects HIV disease progression or that hepatitis B alters the response of HIV to antiretroviral therapy (ART). However, starting ART may be associated with an increased risk of liver inflammation in coinfected individuals, as evidenced by ALT (Alanine Aminotransferase) flares or rising liver enzymes. This may reflect both an immune response against hepatitis B and/or drug toxicity.
For more information, visit the Centers for Disease Control and Prevention website to learn about HIV/AIDS and Viral Hepatitis guidelines and resources.