Hepatitis Delta Virus Image

Due to overlapping transmission routes, some individuals are multiply infected with HIV and hepatitis B (HBV) and/or hepatitis C virus (HCV). Some also carry hepatitis delta virus (HDV), a defective virus that can only replicate in the presence of HBV. Two recent studies looked at HIV positive patients coinfected with multiple hepatitis viruses.

HBV-HCV Reciprocal Inhibition

As reported in the November 2007 Journal of Medical Virology, Italian researchers conducted a long-term follow-up study to evaluate the clinical and virological presentation of HBV-HCV coinfection in HIV-infected patients. Hepatitis B infection was determined based on the presence of hepatitis B surface antigen (HBsAg). The study included:

• 5 HIV-HBV-HCV triple-infected patients;

• 4 HIV-HBV coinfected patients;

• 82 HIV-HCV coinfected patients.

Study participants were first observed at an infectious disease unit in Naples between 1990 and 2000, and were followed for 6-16 years. Plasma HBV DNA, HCV RNA, and HIV RNA levels were determined by PCR.

Results

• All 5 HIV-HBV-HCV triple-infected patients showed reciprocal inhibition of viral replication on admission and during follow up.

• At the end of follow up, serum HBsAg clearance was observed in 4 patients and HCV antibody clearance in 1 subject.

• In 2 patients, after HBsAg clearance, evidence of occult HBV infection (continued detectable HBV DNA) was observed, at times associated with hepatic flares.

• None of the 4 patients with HIV-HBV coinfection lost HBsAg, and none of the 82 with HIV-HCV coinfection lost HCV antibodies during follow up.

The authors concluded that, “In HIV positive patients HBV-HCV coinfection is characterized by reciprocal inhibition of viral replication, more evident in HBV expression in plasma and at times by progression to occult HBV infection.”

Liver Fibrosis Severity

In the second study, French investigators assessed the impact of chronic HCV or HDV infection on the severity of liver fibrosis in 134 patients with HIV-HBV coinfection.

The researchers observed a significant association between HDV coinfection (noted in 13 subjects) and advanced fibrosis or cirrhosis (stage F3-F4):

• Odds ratio [OR] 7.08 for patients HIV-HBV-HDV;

• OR 10.02 for HIV-HBV-HCV-HDV;

• OR 1.76 for HIV-HBV alone.

Based on these findings, they concluded, “Co-treatment of other multiple viral hepatitis infections should also be taken into consideration, especially in the case of chronic HDV.”

12/11/07

References

 P Filippini, N Coppola, R Pisapia, and others. Virological and clinical aspects of HBV-HCV coinfection in HIV positive patients. Journal of Medical Virology 79(11): 1679-1685. November 2007.

K Lacombe, A Boyd, M Desvarieux, and others. Impact of chronic hepatitis C and/or D on liver fibrosis severity in patients co-infected with HIV and hepatitis B virus. AIDS 21(18): 2546-2549. November 30, 2007.