Natural history of chronic hepatitis B in co-infected patients

HIV co-infection influences the course and natural history of hepatitis B virus (HBV) infection by impairing the quantity and quality of the innate and adaptive immune response. The rates of spontaneous resolution after acute infection and spontaneous anti-HBe and anti-HBs seroconversions are decrea...

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Bibliographic Details
Published in:Journal of hepatology 2006, Vol.44 (1 Suppl), p.S65-S70
Main Authors: Puoti, Massimo, Torti, Carlo, Bruno, Raffaele, Filice, Gaetano, Carosi, Giampiero
Format: Article
Language:English
Subjects:
Disease Progression
Hepatitis B
Hepatitis B, Chronic - complications
Hepatitis B, Chronic - immunology
HIV
HIV Infections - complications
Humans
Immunity, Innate
Natural history
Risk Factors
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Summary:HIV co-infection influences the course and natural history of hepatitis B virus (HBV) infection by impairing the quantity and quality of the innate and adaptive immune response. The rates of spontaneous resolution after acute infection and spontaneous anti-HBe and anti-HBs seroconversions are decreased, and levels of HBV replication are increased in HIV-infected patients. A more rapid progression of liver fibrosis and a higher rate of cirrhosis decompensation (but not hepatocellular carcinoma) have been demonstrated in co-infected patients. The risk of HBV-associated end-stage liver disease and liver-related mortality may be increased by HIV co-infection. Antiretroviral therapy may trigger spontaneous anti-HBe and anti-HBs seroconversion and/or a better immune control of HBV replication by restoring adaptive immunity, but can also increase hepatitis flares. Reactivation of chronic hepatitis B has been observed after suspension of anti-retrovirals with anti-HBV activity or after occurrence of HBV resistance to lamivudine. Future research should focus on: the impact of HIV-induced changes in innate and adaptive immune response and modifications induced by anti-retroviral therapy that may impact on progression of advanced chronic hepatitis B; the association between HBV genotype and clinical course of disease; and the role of occult HBV infection as a co-factor with other causes of liver injury.
ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2005.11.015