HIV Co-infected Patients with HBV And HCV- A Review

The prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection with HIV is significant. Co-infection with the two viruses is not uncommon. It is well established that worldwide approximately 4 to 5 million persons are co-infected with HIV. There is a considerable variation in the prevalence of co-infection in different areas. In the treatment of HIV infection, the use of highly active antiretroviral therapy (HAART) is measured and its discovery has been one of the most useful and dramatic advances in the field of medicine. Highly active antiretroviral therapy was introduced in Malaysia in 1997 for treating HIV infection. The purpose of this study is to investigate the prevalence of HBV and HCV co-infection with HIV. The initiation of HAART for human immune deficiency virus has led an era to focus on other leading causes of morbidity such as hepatitis B and hepatitis C. We will review the evaluating effects of highly active antiretroviral therapy on HIV positive patients co-infected with HBV and HCV and find out its possible outcomes. Knowledge of the effects of various treatments as well as interaction between these viruses is the key to understanding and effectively treating these patients. Recent reviews have discussed many aspects of treatment. We summarize the advanced studies regarding to the progression of HAART including effects of co-infection with hepatitis B and C virus as well as its pharmacotherapeutic outcomes. Accepted: 30-07-201 Submitted: 21-05-2013 Address for Correspondence: Ali Akhthar, Student MS (Clinical Pharmacy), School of Pharmaceutical Sciences, Universiti Sains Malaysia, Palau Penang11800, Malaysia. E-mail: [email protected] Indian Journal of Pharmacy Practice Volume 6 Issue 4 Oct Dec, 2013 7 regional prevalences; high (prevalence 3%) moderate (prevalence 2–2.9%), low (prevalence 1.0–1.9%), and very 19, 20 low (prevalence 1.0%). Among the estimated 40 million persons infected with HIV worldwide, an estimated 2–4 million are chronically infected with HBV and an estimated 4–5 million are chronically infected with HCV. Several factors influenced these coinfection estimates, including geographic differences in the prevalence of chronic infection by age, the efficiency of exposures that account for most transmission, and the prevalence of persons at high risk for infection. Dual infection with HBV and HCV is not uncommon in geographic areas where a high endemic level of both infections is reported, such as Southeast-Asia and 1 Mediterranean. Differences in infectivity between HBV, HCV and HIV have been observed in several settings. HBV and HIV are more efficiently transmitted perinatally and sexually than HCV. In the perinatal setting, maternal coinfection with HIV 22 facilitates the transmission of HCV to newborns. Despite the infection rates in these high-risk groups, rates of infection in the general population have remained low (< 0.5% among adults aged 15–49) in several countries with large populations 23 including China, Malaysia, and Philippines. Human immunodeficiency virus (HIV) Human immunodeficiency virus (HIV) is the worldwide disseminated causative agent of acquired immunodeficiency syndrome (AIDS). HIV is a member of the Lentivirusgenus of Retroviridae family and is grouped in two types named HIV1and HIV-2. These viruses have a notable ability to mutate 66 and adapt to the new conditions of human environment. In many parts of the world, the predominant mode of transmission has always been heterosexual contact. However, the rates of HIV seen in different geographical settings vary widely as the result of a complex interplay of behavioral, biological, social and structural risks (direct determinants) and vulnerabilities (i.e. factors which may not be directly linked to the transmission of the virus, but may increase the chances of the virus spreading in a particular population).Many social and demographic factors also 66 influence the epidemiology of HIV. This striking difference suggests that young girls are particularly susceptible to infection, through having unprotected sex with older, infected, men and perhaps due to 67 starting sex at a very young age. The south-east Asian epidemic has been well documented in Thailand, where HIV initially spread rapidly in the late 1980s among injecting drug users and between sex workers and their clients. The government acted quickly to set up a comprehensive prevention campaign including enforced condom use in establishments used by sex workers and a mass 68 advertising campaign. In the past 2 decades, the human immunodeficiency virus (HIV) has rampaged across the globe leaving virtually no country untouched. Despite advances in our understanding of the social, behavioural and biological factors that directly increase the risk of HIV transmission, approximately 14,500 individuals are infected 65 daily. Hepatitis B Co-Infection with HIV HBV is a deoxyribonucleic acid (DNA) virus. In the United States, the prevalence of chronic carriage of hepatitis B surface antigen (HBsAg) is present in less than 1% of the 24,25 population. The course of hepatitis B in HIV co-infected patients is characterized by the increased prevalence of markers of active viral replication (hepatitis B e antigen [HBeAg], HBV DNA). Indeed, viral replication is even further enhanced when CD4 counts continue to decrease over 26,15 time. HBV is transmitted by percutaneous and mucous membrane exposures to infectious Throughout the world more than 350 million persons are chronically infected with HBV and approximately 33 million 27-28 persons are infected with HIV. Individual Factors Age Gender Lack of knowledge Type of partnerships Protective Behaviours (e.g. use of condoms) Presence of other sexually transmitted infections (STIs) Injecting drug use Male circumcision status Denial of risk Social and Demographic Factors Age structure of population Gender-based education rates Rates of urbanization Access to effective STI treatment Availability and use of commercial sex Sexual mixing patterns Population mobility Services for drug users Safety of blood transfusion Rates of male circumcision Structural Factors Income distribution Policy environment Position of women Wealth of population 66 Table 1: Social and demographic factors that influenced the epidemiology of HIV. Aliakhtar HIV Co-infected Patients with HBV AND HCVA Review Indian Journal of Pharmacy Practice Volume 6 Issue 4 Oct Dec, 2013 8 HCV infection leads to chronic hepatitis in 85% of patients, and those patients have a 20% risk of developing cirrhosis 41-43 during the subsequent 2 decades. Many studies suggest that HIV disease modifies the natural history of chronic HCV infection; this leads to an accelerated course of progression from chronic active hepatitis to cirrhosis, end-stage liver 44-48 disease, and death. Risk factors associated with acquiring HCV infection include transfusion of blood and blood products and transplantation of solid organs from infected donors, illegal injection drug use, unsafe therapeutic injections, occupational exposure to blood (primarily contaminated needle sticks), birth to an infected mother, sex with an infected partner, and sex with 49 multiple partners. Prior to HAART, people with HIV-HCV co-infection were reported to have higher HCV viral load and accelerated hepatic fibrosis. Rates of HCV-related liver disease progression appeared to be 5±10 fold higher in people with 50 HIV-HCV co-infection. In contrast; there was inconclusive evidence to support a role for HCV in acceleration of HIV 51 disease progression.