Prevalence and impact of GBV-C, SEN-V and HBV occult infections in HIV-HCV co-infected patients oil HCV therapy
ABSTRACT It has been suggested that, in HIV-HCV co-infected patients, co-infections with other viruses may affect the response to HCV therapy. We aimed to assess the prevalence of GBV-C, SEN-V and occult HBV infections, their impact on HCV and HIV infections and on the response to HCV therapy in HIV-HCV co-infected patients.
Three-hundred and sixty eight patients were tested before starting interferon-ribavirin for the presence of occult hepatitis B DNA, GBV-C RNA and SEN-V DNA by using real time PCR. Clinical, immunological, virological, histological characteristics and response to HCV therapy were compared according to the presence or not of each viral co-infection.
HBV DNA, GBV-C RNA and SEN-V DNA were found in 5 (1.4%, CI95%: 0.2-2.4%), 104 (29.9%, CI95%: 25.1-34.7%) and 209 patients (57.9%, CI95%: 52.8-63.0%), respectively. GBV-C positive patients had significantly higher CD4 count at baseline, during and after HCV therapy, even after stratification on antiretroviral treatment. No other significant difference was observed according to the presence or not of GBV-C or SEN-V co-infection, in particular regarding virological responses to HCV combination therapy.
There is no reason to withhold HCV therapy in HIV infected patients who have access to HAART, because of occult HBV, GBV-C or SEN-V co-infections.
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ABSTRACT: Since the pivotal trials conducted over the last few years which have used the combination of pegylated interferon along with fixed low doses (800mg/day) of ribavirin and have provided treatment for 12 months, regardless the kinetics of hepatitis C virus (HCV) viral load during therapy, great progress has been made in the treatment of chronic hepatitis C in HIV-infected patients. Results approaching those seen in HCV-monoinfected patients can be obtained with optimal dosages of ribavirin, extension of treatment beyond 48 weeks in the absence of rapid virologic response and/or in patients older than 40 years, with severe fibrosis (METAVIR score F3 or F4) and/or with high HCV viral load and with a better management of HIV treatment in order to avoid a negative interaction between HCV and HIV therapies (interaction between abacavir and ribavirin) and to improve the tolerance of HCV therapy (Didanosine should never be used with ribavirin, Zidovudine and Stavudine should be avoided when possible with ribavirin).Gastroentérologie Clinique et Biologique 03/2009; 33. DOI:10.1016/S0399-8320(09)72447-9 · 1.14 Impact Factor
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ABSTRACT: BACKGROUND:: This study assessed HIV-HBV co-infection in southern Africa in terms of prevalence, viral characteristics, occult HBV, and the effect of lamivudine versus tenofovir containing first-line combination antiretroviral treatment (cART) on HBV-related outcomes. METHODS:: Multicenter prospective HIV-infected adult cohort in Zambia and South Africa at cART initiation. Outcomes by month 12 on cART were immunological recovery, HBsAg loss, viral suppression and drug-resistance. We used descriptive statistics, logistic regression and linear mixed models. RESULTS:: Of the 1,087 participants, 92 were HBsAg seropositive, yielding a sample-weighted prevalence of 7.4% (95%CI 5.6-9.2), with 76% genotype HBV-A1. The estimated CD4 recovery on cART was similar between HIV mono-infection and HIV-HBV co-infection groups, and between lamivudine and tenofovir-treated participants. HBsAg loss was documented in 20% (4/20) of lamivudine-treated and 18% (3/17) of tenofovir-treated participants (p=0.305). Viral suppression (HBV-DNA<20 IU/mL) was achieved in 61.5% (16/26) of lamivudine-treated and 71.4% (15/21) of tenofovir-treated participants (p=0.477). HBV pol sequencing demonstrated M204I (n=3) and N236T (n=1) resistance-associated mutations in four of eight (50%) lamivudine-treated participants, and none in tenofovir-treated participants. Occult HBV infection was present in 13.3% prior to cART, but by month 12 HBV-DNA was below limit of detection (<15 IU/mL) in 90.5% (19/21) of lamivudine-treated and 100% (18/18) of tenofovir-treated participants (p=0.179). CONCLUSIONS:: Tenofovir-containing first-line cART is preferred for HIV-HBV co-infection in Africa, because of a superior resistance profile relative to lamivudine monotherapy. Extended follow-up will be needed to determine long-term complications of occult HBV co-infection. Improved access to HBsAg screening and tenofovir is needed.JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2013; DOI:10.1097/QAI.0b013e3182a60f7d · 4.39 Impact Factor
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ABSTRACT: Occult hepatitis B infection (OBI), is characterized by low level hepatitis B virus (HBV) DNA in circulating blood and/or liver tissue. In clinical practice the presence of antibody to hepatitis B core antigen in hepatitis B surface antigen (HBsAg)-/anti-HBs-negative subjects is considered indicative of OBI. OBI is mostly observed in the window period of acute HBV infection in blood donors and in recipients of blood and blood products, in hepatitis C virus chronic carriers, in patients under pharmacological immunosuppression, and in those with immunodepression due to HIV infection or cancer. Reactivation of OBI mostly occurs in anti-HIV-positive subjects, in patients treated with immunosuppressive therapy in onco-hematological settings, in patients who undergo hematopoietic stem cell transplantation, in those treated with anti-CD20 or anti-CD52 monoclonal antibody, or anti-tumor necrosis factors antibody for rheumatological diseases, or chemotherapy for solid tumors. Under these conditions the mortality rate for hepatic failure or progression of the underlying disease due to discontinuation of specific treatment can reach 20%. For patients with OBI, prophylaxis with nucleot(s)ide analogues should be based on the HBV serological markers, the underlying diseases and the type of immunosuppressive treatment. Lamivudine prophylaxis is indicated in hemopoietic stem cell transplantation and in onco-hematological diseases when high dose corticosteroids and rituximab are used; monitoring may be indicated when rituximab-sparing schedules are used, but early treatment should be applied as soon as HBsAg becomes detectable. This review article presents an up-to-date evaluation of the current knowledge on OBI.