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HIV/HBV Coinfection

AZT (Retrovir) Ups Anemia Risk in HIV-HCV Coinfected Patients, But Rate Remains Low

Since the advent of effective antiretroviral therapy has reduced the rate of death due to opportunistic illnesses and other AIDS-related causes, liver disease has emerged as a major cause of death among HIV positive people. HIV, in turn, has also influenced rates of death among patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, according to a study published in the February 2008 Journal of Hepatology.

In this analysis, Patrick Marcellin and colleagues estimated mortality related to HCV and HBV infection in France. A random sample of 999 death certificates was obtained from among all 65,000 French death certificates in 2001 that listed HBV, HCV, hepatitis, liver disease, possible complication of cirrhosis, bacterial infection, HIV, or transplantation as causes of death. Physicians who reported these deaths were sent a questionnaire to identify how many deaths were related to HBV or HCV infection. Death rates were then estimated according to national population census data.


Results

• The estimated annual number of deaths associated with HCV was 3618 (6.1 deaths per 100,000 inhabitants).

• The estimated annual number of deaths associated with HBV was 1507 (2.5 per 100,000 inhabitants).

• The estimated number of deaths attributable to HCV was 2646 (4.5 per 100,000 inhabitants).

• The estimated number of deaths attributable to HBV was 1327 (2.2 per 100,000 inhabitants).

• In the HCV infected group, 95% had cirrhosis and 33% had hepatocellular carcinoma (HCC).

• In the HBV infected group, the rates were similar: 93% and 35%, respectively.

• 11% percent of these deaths occurred in patients with HIV coinfection.

• Deaths related to hepatitis B or C occurred at an earlier age in patients with a history of excessive alcohol consumption. 

"In France, 4000-5000 deaths related to HCV and HBV infection occurred in 2001," the researchers concluded. "Alcohol consumption and HIV infection were important co-factors."

They added that, "These data emphasize the need for ongoing, efficient public health programs that include screening, management, and counseling for HCV- and HBV-infected individuals."

02/29/08

Reference

P Marcellin, F Pequignot, E Delarocque-Astagneau, and others. Mortality related to chronic hepatitis B and chronic hepatitis C in France: Evidence for the role of HIV coinfection and alcohol consumption. Journal of Hepatology 48(2): 200-207. February 2008.

HAART Containing Tenofovir (Viread) plus Emtricitabine (Emtriva) is Effective for HIV-HBV Coinfected Patients

Several recent studies have added to the evidence that structured interruption of antiretroviral therapy can lead to detrimental outcomes for people with HIV. The disadvantages of treatment interruption may be even more pronounced among HIV positive individuals with hepatitis B virus (HBV) coinfection, since some drugs used to treat HIV are also active against HBV, including 3TC (lamivudine; Epivir), emtricitabine (Emtriva), and tenofovir (Viread). 

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