Sandbox/HIV

HIV co infections

Coinfection	Epidemeology	Clinical features	Diagnosis	Treatment	Prevention
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Hepatitis B	Hepatitis B virus (HBV) is the leading cause of chronic liver disease worldwide., Globally and in North America, approximately 10% of HIV-infected patients have evidence of chronic HBV infection. , In countries with a low prevalence of endemic chronic HBV infection, the virus is transmitted primarily through sexual contact and injection drug use, whereas perinatal and early childhood exposures are responsible for most HBV transmission in higher prevalence regions. Although the general modes of transmission are similar to HIV, HBV is transmitted more efficiently than HIV. HBV has an average incubation period of 90 days (range 60–150 days) from exposure to onset of jaundice and 60 days (range 40–90 days) from exposure to onset of abnormal liver enzymes. Genotypes of HBV (A–H) have been identified with different geographic distributions. Genotype A is most common among patients in North America and Western Europe.	Acute infection may be asymptomatic. Symptoms may include right upper quadrant abdominal pain, nausea, vomiting, fever, and arthralgias with or without jaundice. Most patients with chronic HBV infection are asymptomatic or have non-specific symptoms, such as fatigue, until they develop cirrhosis and signs of portal hypertension (i.e., ascites, variceal bleeding, coagulopathy, jaundice, or hepatic encephalopathy). Hepatocellular carcinoma (HCC) is asymptomatic in its early stages and usually, but not always, occurs in the setting of hepatitis-B or hepatitis-C related cirrhosis.	All HIV-infected patients should be tested for HBV infection. Initial testing should include serologic testing ,for surface antigen (HBsAg), hepatitis B core antibody (anti-HBc total), and hepatitis B surface antibody (anti-HBs). Chronic HBV infection is defined as persistent HbsAg detected on 2 occasions at least 6 months apart. Patients with chronic HBV infection should be further tested for HBV e-antigen (HBeAg), antibody to HBeAg (anti-HBe), and HBV DNA The inactive chronic hepatitis B state is characterized by a negative HBeAg, normal ALT levels, and an HBV DNA level <2,000 international units/mL. Patients diagnosed with chronic HBV infection should have a complete blood count, ALT, aspartate aminotransferase (AST), albumin and bilirubin levels, and prothrombin time monitored at baseline and every 6 months thereafter to assess severity and progression of liver disease Liver biopsy with histologic examination remains a valuable tool for characterizing the activity and severity of chronic hepatitis B and may provide important information in monitoring disease progression, guiding treatment, and excluding other diseases	The ultimate treatment goals in HIV/HBV co-infection are the same as for HBV monoinfection: to prevent , disease progression and to reduce HBV-related morbidity and mortality. Anti-HBV therapy is indicated for elevated ALT and elevated HBV DNA >2,000 international units/mL or significant fibrosis (AI) For HIV/HBV co-infected individuals, ART must include two drugs active against HBV, preferably tenofovir .and emtricitabine, regardless of the level of HBV DNA (AIII). Such a regimen will reduce the likelihood of immune reconstitution inflammatory syndrome (IRIS) against HBV	HBV is primarily transmitted by percutaneous or mucosal exposure to infectious blood or body fluids. Therefore, HIV-infected patients should be counseled about transmission risks for HBV and avoidance of behaviors associated with such transmission. Counseling should emphasize the transmission risks associated with sharing needles and syringes, tattooing or body-piercing, and sexual transmission. All household members and sexual contacts of patients with HBV should be screened and all susceptible contacts should receive both hepatitis A and B vaccines regardless of whether they are HIV infected. Hepatitis B immunization is the most effective way to prevent HBV infection and its consequences Most HIV-infected patients with isolated anti-HBc are HBV DNA negative and not immune to HBV infection. They should be vaccinated with a complete series of hepatitis B vaccine followed by anti-HBs testing (BII).34,35 Hepatitis A vaccination is recommended for all hepatitis A antibody-negative patients who have chronic liver disease, are men who have sex with men, or who are injection drug users Patients with chronic hepatitis B disease should be advised to avoid alcohol consumption
Hepatitis C	Hepatitis C virus (HCV) is a single-stranded RNA virus; the estimated worldwide prevalence of HCV infection is 2% to 3%, which translates to an estimated 170 million infected individuals of whom approximately 3.2 million live in the United States.1 Seven distinct HCV genotypes have been described.2. Approximately, 20% to 30% of HIV-infected patients in the United States are co-infected with HCV.5,6 HCV is approximately 10 times more infectious than HIV through percutaneous blood exposures and has been shown to survive for weeks in syringes.7-9 Heterosexual transmission of HCV is uncommon but more likely in those whose partners are co-infected with HIV and HCV.13,1 Incidence of mother-to-child HCV transmission is increased when mothers are HIV-co-infected, reaching rates of 10% to 20%.28,29	'
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