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Iannetta M, Crea AMA, Di Lorenzo A, Campogiani L, Teti E, Malagnino V, Compagno M, Coppola L, Piermatteo L, Palmieri G, Cimino C, Salpini R, Zingaropoli MA, Ciardi MR, Mastroianni CM, Parisi SG, Svicher V, Andreoni M, Sarmati L. Hepatitis B-related hepatic flare during immune reconstitution syndrome after antiretroviral treatment initiation in an HBV surface antigen-positive patient with HIV: viroimmunological and histological characterization. Open Forum Infect Dis 2022; 9:ofac451. [PMID: 36092833 PMCID: PMC9454030 DOI: 10.1093/ofid/ofac451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
HIV and hepatitis B virus (HBV) coinfection is relatively common. Initiation of antiretroviral therapy (ART) in people with HIV (PWH) causes a progressive restoration of cell-mediated immune functions. In the presence of overt or occult coinfections, immune restoration might lead to immune reconstitution inflammatory syndrome (IRIS). Here, we describe the clinical, immunological, virological, and histological characterization of a case of HBV-related IRIS hepatitis in a PWH after ART initiation. A liver biopsy was performed during HBV-related IRIS hepatic flare, and liver samples were analyzed through immunohistochemistry and molecular techniques, with the assessment of intrahepatic HBV-DNA, covalently closed circular DNA, and HBV pregenomic RNA through a droplet digital polymerase chain reaction system. Immune activation and senescence were also longitudinally assessed. In this clinical case, the hepatic flare occurred 6 weeks after ART initiation with a therapeutic regimen including tenofovir alafenamide (TAF) and emtricitabine (FTC). The episode was self-limiting, characterized by hyperactivation of peripheral blood CD4+ and CD8+ T-lymphocytes, and resolved without ART discontinuation, leading to the achievement of HBsAg seroconversion (HBsAg-/HBsAb+) and HBV-DNA plasma undetectability. Notably, hyperactivation of the immune system plays a pivotal role in promoting the control of HBV replication, thus triggering the achievement of HBsAg seroconversion during treatment with TAF/FTC.
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Affiliation(s)
- M Iannetta
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - A M A Crea
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - A Di Lorenzo
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - L Campogiani
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - E Teti
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - V Malagnino
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - M Compagno
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - L Coppola
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - L Piermatteo
- Department of Experimental Medicine, Tor Vergata University , Rome , Italy
| | - G Palmieri
- Department of Biomedicine and Prevention, Tor Vergata University , Rome , Italy
| | - C Cimino
- Department of Biomedicine and Prevention, Tor Vergata University , Rome , Italy
| | - R Salpini
- Department of Experimental Medicine, Tor Vergata University , Rome , Italy
| | - M A Zingaropoli
- Department of Public Health and Infectious Diseases, Sapienza University , Rome , Italy
| | - M R Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University , Rome , Italy
| | - C M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University , Rome , Italy
| | - S G Parisi
- Department of Molecular Medicine, University of Padova , Padua , Italy
| | - V Svicher
- Department of Experimental Medicine, Tor Vergata University , Rome , Italy
- Department of Biology, Tor Vergata University , Rome , Italy
| | - M Andreoni
- Department of System Medicine, Tor Vergata University , Rome , Italy
| | - L Sarmati
- Department of System Medicine, Tor Vergata University , Rome , Italy
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Kumar RN, Stosor V. Advances in Liver Transplantation for Persons with Human Immunodeficiency Infection. Curr Infect Dis Rep 2022; 24:39-50. [PMID: 35308580 PMCID: PMC8922075 DOI: 10.1007/s11908-022-00776-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca N. Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611 USA
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Pérez-González A, Suárez-García I, Ocampo A, Poveda E. Two-Drug Regimens for HIV-Current Evidence, Research Gaps and Future Challenges. Microorganisms 2022; 10:433. [PMID: 35208887 PMCID: PMC8880461 DOI: 10.3390/microorganisms10020433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
During the last 30 years, antiretroviral treatment (ART) for human immunodeficiency virus (HIV) infection has been continuously evolving. Since 1996, three-drug regimens (3DR) have been standard-of-care for HIV treatment and are based on a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs). The effectiveness of first-generation 3DRs allowed a dramatic increase in the life expectancy of HIV-infected patients, although it was associated with several side effects and ART-related toxicities. The development of novel two-drug regimens (2DRs) started in the mid-2000s in order to minimize side effects, reduce drug-drug interactions and improve treatment compliance. Several clinical trials compared 2DRs and 3DRs in treatment-naïve and treatment-experienced patients and showed the non-inferiority of 2DRs in terms of efficacy, which led to 2DRs being used as first-line treatment in several clinical scenarios, according to HIV clinical guidelines. In this review, we summarize the current evidence, research gaps and future prospects of 2DRs.
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Affiliation(s)
- Alexandre Pérez-González
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
- Infectious Diseases Unit, Department of Internal Medicine, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
| | - Inés Suárez-García
- Infectious Diseases Group, Internal Medicine Department, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, 28703 San Sebastián de los Reyes, Spain;
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, 28670 Madrid, Spain
- CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Antonio Ocampo
- Infectious Diseases Unit, Department of Internal Medicine, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
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Ouafik M, Buret L, Belche JL, Scholtes B. Mapping the current knowledge in syndemic research applied to men who have sex with men: a scoping review protocol. BMJ Open 2020; 10:e041238. [PMID: 33247024 PMCID: PMC7703413 DOI: 10.1136/bmjopen-2020-041238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) are disproportionally affected by a number of health conditions that are associated with violence, stigma, discrimination, poverty, unemployment or poor healthcare access. In recent years, syndemic theory provided a framework to explore the interactions of these health disparities on the biological and social levels. Research in this field has been increasing for the past 10 years, but methodologies have evolved and sometimes differed from the original concept. The aim of this paper is to provide an overview of the existing literature on syndemic theory applied to MSM in order to identify knowledge gaps, inform future investigations and expand our understanding of the complex interactions between avoidable health conditions in a vulnerable population. METHODS AND ANALYSIS The proposed scoping review will follow the methodological framework developed by Arksey and O'Malley with subsequent enhancements by Levac et al, Colquhoun et al and Peters et al as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review. A systematic search of MEDLINE, PsycInfo, Scopus, Cochrane Central Register of Controlled Trials and ProQuest Sociological Abstracts will be conducted. Reference lists of the included studies will be hand-searched for additional studies. Screening and data charting will be achieved using DistillerSR. Data collating, summarising and reporting will be performed using R and RStudio. Tabular and graphical summaries will be presented, alongside an evidence map and a descriptive overview of the main results. ETHICS AND DISSEMINATION This scoping review does not require ethical approval. Data and code will be made accessible after manuscript submission. Final results will be disseminated through publication in a peer-reviewed journal and collaboration with grassroots Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) organisations. REGISTRATION This protocol was registered on manuscript submission on the Open Science Framework at the following address: https://osf.io/jwxtd; DOI: 10.17605/OSF.IO/JWXTD.
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Affiliation(s)
- Maxence Ouafik
- General Practice Department - Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Laetitia Buret
- General Practice Department - Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Jean-Luc Belche
- General Practice Department - Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Beatrice Scholtes
- General Practice Department - Primary Care and Health Research Unit, Liege University, Liege, Belgium
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Abstract
: With current antiretroviral therapy, the lifespan of newly diagnosed persons with HIV (PWH) approaches that of uninfected persons. However, metabolic abnormalities related to both the disease and the virus itself, along with comorbidities of aging, have resulted in end-organ disease and organ failure as a major cause of morbidity and mortality. Solid organ transplantation is a life-saving therapy for PWH who have organ failure, and the approval of the HIV Organ Policy Equity Act has opened and expanded opportunities for PWH to donate and receive organs. The current environment of organ transplantation for PWH will be reviewed and future directions of research and treatment will be discussed.
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Farooq PD, Sherman KE. Hepatitis B Vaccination and Waning Hepatitis B Immunity in Persons Living with HIV. Curr HIV/AIDS Rep 2020; 16:395-403. [PMID: 31468298 DOI: 10.1007/s11904-019-00461-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Persons with HIV are at a higher risk for acquiring HBV (hepatitis B virus) than the general population due to shared modes of transmission and are significantly more likely to develop and die from sequelae of chronic HBV infection. Early vaccination is key to achieving HBV protective immunity, but response rates are still much lower than in the general population, ranging from 35 to 70%. Individuals with HIV also experience more rapidly waning immunity than those without HIV. Strategies to augment initial response and improve long-term immunity in individuals with HIV include alterations in dose, frequency, and the use of immune adjuvants. RECENT FINDINGS Recent studies have focused on the use of different vaccine formulations, the use of vaccine adjuvants, increased number and strength of vaccine dosages, increased dose frequency, alternative routes of administration, dual vaccinations, and the use of booster vaccines. Although no consensus has been reached on the use of certain vaccination regimens, three and four double-dose vaccine schedules via the intramuscular route have demonstrated higher initial response rates. Early vaccination when CD4 cell counts are greater than 350/mm3 with low viral loads has been shown to improve initial response, along with completion of immunization series. Adjuvants such as TLR4 and TLR9 agonists appear to improve response to HBV vaccination, but further research is needed in individuals with HIV. Persons with HIV have significant lower initial and long-term seroresponse rates after HBV vaccination than immunocompetent individuals. Recent and ongoing studies continue to evaluate multiple strategies to improve these rates within a uniquely susceptible population.
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Affiliation(s)
- Priya D Farooq
- Division of Digestive Diseases, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0595, USA
| | - Kenneth E Sherman
- Division of Digestive Diseases, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0595, USA.
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Rowley MW, Patel A, Zhou W, Wong M, Seetharam AB. Immune Reconstitution Syndrome with Initiation of Treatment of HBV/HIV Co-infection: Activity Flare associated with E antigen Seroconversion. Ann Hepatol 2019; 18:220-224. [PMID: 31113594 DOI: 10.5604/01.3001.0012.7918] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/17/2017] [Indexed: 02/04/2023]
Abstract
Immune reconstitution syndrome is a recognized complication with initiation of highly active antiretroviral therapy for acquired immune deficiency syndrome patients co-infected with hepatitis B. Hepatitis B flares are seen in 20%-25% of patients after initiation of highly active antiretroviral therapy, an estimated 1%-5% of whom develop clinical hepatitis. We present a case of highly active antiretroviral therapy initiation for HIV that led to a flare of HBV activity despite antiviral therapy directed towards both. Liver biopsy and longitudinal serologic evaluation lend support to the hypothesis that the flare in activity was representative of IRIS. Importantly, we document eAg/eAb seroconversion with the IRIS phenomenon.
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Affiliation(s)
- Michael W Rowley
- Department of Internal Medicine, Banner University Medical Center Phoenix, Phoenix, AZ, USA; Transplant and Advanced Liver Disease Center, Banner University Medical Center Phoenix, Phoenix, AZ, USA.
| | - Amitkumar Patel
- Department of Gastroenterology, Banner University Medical Center Phoenix, Phoenix, AZ, USA; Transplant and Advanced Liver Disease Center, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Wendi Zhou
- Department of Pathology, Banner University Medical Center Phoenix, Phoenix, AZ, USA; University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Mark Wong
- Transplant and Advanced Liver Disease Center, Banner University Medical Center Phoenix, Phoenix, AZ, USA; University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Anil B Seetharam
- Transplant and Advanced Liver Disease Center, Banner University Medical Center Phoenix, Phoenix, AZ, USA; University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
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8
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Ba A, Ndiaye FK, Djeng YJ, Cames C, Diack A, N'diaye O. Impact of Highly Active Antiretroviral Therapy on Chronic Hepatitis B Serological Markers among Senegalese HIV Co-infected Children. Int J MCH AIDS 2019; 8:131-137. [PMID: 31824751 PMCID: PMC6895772 DOI: 10.21106/ijma.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Coinfection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) causes complex interactions. The aim of this study was to evaluate the seroprevalence and HBV evolution among HIV coinfected children receiving highly active antiretroviral therapy (HAART). METHODS A descriptive cross-sectional study was carried out among 252 HIV infected children enrolled in the Hôpital d'enfants Albert Royer, Dakar, Senegal, from April 2013 to March 2015. Clinical characteristics, immuno-virological status, alanine aminotransferase (ALT) levels, and HBV serological marker were taken from the patients' medical records. RESULTS Overall, 7 children were HBsAg positive with a determinate prevalence rate of 2.8%. Median age at HIV diagnosis was 3.5 years (1.3-14.4 years). According to World Health Organization (WHO) staging, 40.1% of children were stage 4 and 25.8% were stage 3. Of the 7 HIV/HBV-co-infected children, 6 (86%) received lamivudine alone at initiation of treatment, and only one child received tenofovir associated with emtricitabine. Overall median HAART duration treatment including lamivudine alone or tenofovir+lamivudine (or emtricitabine) was 7.7 years (3.3-11.3). Only the two children (29%) receiving lamivudine during follow-up had high HBV DNA load despite having good immuno-virological status. Suppression of HBV DNA replication was achieved in 5 (71.4%) of 7 children. CONCLUSION AND GLOBAL HEALTH IMPLICATION HIV/HBV coinfection prevalence was low in our study. HBsAg and HBeAg loss were low while suppression of HBV DNA replication was still higher on tenofovir. Screening and monitoring HBV infection among all HIV infected children are required to direct treatment in order to improve children HBV/HIV coinfected outcome.
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Affiliation(s)
- Abou Ba
- Centre Hospitalier National d'Enfants Albert Royer, BP: 25755-Fann, Dakar, Senegal
| | - Fatou K Ndiaye
- Centre Hospitalier National d'Enfants Albert Royer, BP: 25755-Fann, Dakar, Senegal
| | - Yaay J Djeng
- Centre Hospitalier National d'Enfants Albert Royer, BP: 25755-Fann, Dakar, Senegal
| | - Cecile Cames
- Institut de Recherche pour le Développement (IRD), UMI233 IRD, INSERM U1175, Université de Montpellier, Montpellier, France
| | - Aminata Diack
- Centre Hospitalier National d'Enfants Albert Royer, BP: 25755-Fann, Dakar, Senegal
| | - Ousmane N'diaye
- Centre Hospitalier National d'Enfants Albert Royer, BP: 25755-Fann, Dakar, Senegal
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Li D, Chen Q, Tao C. BCP/PC mutation prevalence and their association with HBV replication in HIV/HBV co-infected patients. Arch Virol 2018; 163:2829-2833. [PMID: 29948380 DOI: 10.1007/s00705-018-3900-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/20/2018] [Indexed: 02/05/2023]
Abstract
The high prevalence (14.3%) of HIV/HBV co-infections reported in west China makes it necessary to screen concurrent HBV infection in HIV carriers. HBV B genotype was shown to be dominant in 54 cases of HIV/HBV co-infection, accounting for 81.48% of the total. The total drug resistance rate observed was 3.70%. A1762T, G1764A and G1896A mutations were common mutations identified in the BCP/PC region. However, the prevalence of the G1896A mutation was significantly high among the HBeAg negative HIV/HBV co-infected patients, and may be associated with high HBV replication. Mutations in the PC region are related to the loss in synthesis of HBeAg and may accelerate HBV replication in HIV positive patients.
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Affiliation(s)
- Dongdong Li
- Division of Clinical microbiology, Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, Republic of China
| | - Qixia Chen
- Division of Clinical microbiology, Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, Republic of China
| | - Chuanmin Tao
- Division of Clinical microbiology, Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, Republic of China.
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Lara AN, Sartori AM, Fonseca MO, Lopes MH. Long-term protection after hepatitis B vaccination in people living with HIV. Vaccine 2017; 35:4155-4161. [PMID: 28669615 DOI: 10.1016/j.vaccine.2017.06.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hepatitis B vaccine is important in people living with HIV (PLHIV) since both viruses have the same transmission routes and co-infection has greater morbidity. PLHIV usually have poor response to hepatitis B vaccine. The duration of immunity in PLHIV is unknown. The objective of this study is to evaluate the duration of serological response and clinical protection provided by hepatitis B vaccination in PLHIV. METHODS Retrospective study of a PLHIV cohort primarily vaccinated for hepatitis B virus (HBV) from 2001 to 2002. Markers of infection and protection from HBV were investigated in those individuals who were still attending the outpatient clinic, in São Paulo, Brazil from 2012 to 2014. Three groups were analyzed. Group 1: adults who responded to primary vaccine series. Group 2: non-responders to primary vaccine series. Group 3: subjects from both Groups 1 and 2 who did not receive any booster doses after seroconversion. RESULTS A cohort of 121 PLHIV was analyzed for seroconversion and persistence of anti-HBs. The majority were female (54.5%) and mean age was 50.1years. After 11years, none of the patients had serologic evidence of HBV infection. Overall, 41/58 (70.7%) of the initial responders (Group 1) had maintained anti-HBs≥10mIU/mL. Greater CD4+ values and anti-HBs>100mIU/mL at the time of first vaccine series were associated with persistence of anti-HBs. During the time of evaluation, 35/63 (55.6%) of the initial non-responders (Group 2) successfully seroconverted (anti-HBs≥10mIU/mL) in response to one or more booster doses. From the time of their seroconversion, 70 of the patients did not receive any further booster doses (Group 3). After 10years, 54/70 (77.1%) of these individuals has maintained anti-HBs≥10mIU/mL. CONCLUSIONS Evaluation of long-term immunity for hepatitis B in PLHIV following vaccination showed a strong persistence of anti-HBs and no serologic evidence of HBV infection. Boosters may be effective in PLHIV non-responders to primary vaccination.
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Affiliation(s)
- Amanda Nazareth Lara
- Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Ana Marli Sartori
- Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marise Oliveira Fonseca
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marta Heloísa Lopes
- Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Debes JD, Bohjanen PR, Boonstra A. Mechanisms of Accelerated Liver Fibrosis Progression during HIV Infection. J Clin Transl Hepatol 2016; 4:328-335. [PMID: 28097102 PMCID: PMC5225153 DOI: 10.14218/jcth.2016.00034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 12/23/2022] Open
Abstract
With the introduction of antiretroviral therapy (ART), a dramatic reduction in HIV-related morbidity and mortality has been observed. However, it is now becoming increasingly clear that liver-related complications, particularly rapid fibrosis development from ART as well as from the chronic HIV infection itself, are of serious concern to HIV patients. The pathophysiology of liver fibrosis in patients with HIV is a multifactorial process whereby persistent viral replication, and bacterial translocation lead to chronic immune activation and inflammation, which ART is unable to fully suppress, promoting production of fibrinogenic mediators and fibrosis. In addition, mitochondrial toxicity, triggered by both ART and HIV, contributes to intrahepatic damage, which is even more severe in patients co-infected with viral hepatitis. In recent years, new insights into the mechanisms of accelerated fibrosis and liver disease progression in HIV has been obtained, and these are detailed and discussed in this review.
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Affiliation(s)
- Jose D. Debes
- Department of Medicine, Division of Infectious Disease and International Medicine, University of Minnesota, Minneapolis, MN, USA
- *Correspondence to: Jose D. Debes, Department of Medicine, Division of Infectious Disease and International Medicine, University of Minnesota, 2001 6th Street SE, Minneapolis, MN 55455, USA. Tel: +1-612-624-6353, Fax: +1-612-301-1292, E-mail:
| | - Paul R. Bohjanen
- Department of Medicine, Division of Infectious Disease and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
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Delgado-Enciso I, Espinoza-Gómez F, Ochoa-Jiménez R, Valle-Reyes S, Vásquez C, López-Lemus UA. Dengue Infection in a Human Immunodeficiency Virus-1 Positive Patient Chronically Infected with Hepatitis B Virus in Western Mexico. Am J Trop Med Hyg 2016; 96:122-125. [PMID: 27895272 DOI: 10.4269/ajtmh.16-0477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/27/2016] [Indexed: 01/12/2023] Open
Abstract
Human immunodeficiency virus (HIV) and dengue coinfection has not been extensively studied. We report herein a case of dengue serotype 1 infection in an HIV-1-positive patient coinfected with hepatitis B virus (HBV) in Colima State, Mexico. CD4+ cells and HIV-1 viremia remained at normal levels, and no severe complications were observed during this multiple viral infection. The alanine transaminase and aspartate transaminase values were elevated before and during dengue infection. Surprisingly, these parameters were significantly reduced 2 months later. Because of the lack of evidence regarding this multiple viral interaction, further research is required to understand the biologic and clinical course of dengue infection in HIV-1/HBV coinfected patients, especially in tropical regions where dengue virus transmission is highly active.
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Affiliation(s)
- Iván Delgado-Enciso
- School of Medicine, University of Colima, Colima, México.,State Cancer Institute, Department of Health, Colima, México
| | - Francisco Espinoza-Gómez
- School of Medicine, University of Colima, Colima, México.,Department of Internal Medicine, Regional Hospital of Colima, Department of Health, Colima, México
| | - Rodolfo Ochoa-Jiménez
- Department of Internal Medicine, Regional Hospital of Colima, Department of Health, Colima, México
| | | | | | - Uriel A López-Lemus
- School of Medicine, University of Colima, Colima, México. .,Center for Gene Therapy, Hematologic Malignancies and Stem Cell Transplantation Institute, City of Hope, Duarte, California
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13
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Rajbhandari R, Barton K, Juncadella AC, Rubin AK, Ajayi T, Wu Y, Ananthakrishnan AN, Chung RT. Discontinuity of care for mothers with chronic hepatitis B diagnosed during pregnancy. J Viral Hepat 2016; 23:561-8. [PMID: 26940754 DOI: 10.1111/jvh.12524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/02/2016] [Indexed: 01/05/2023]
Abstract
Assiduous measures are taken to prevent perinatal transmission of hepatitis B virus (HBV) to infants; it is unclear whether the mothers receive appropriate care for their chronic HBV. We sought to assess the quality of HBV care in hepatitis B surface antigen (HBsAg)-positive mothers following pregnancy. HBsAg-positive women (n = 243) who had sought prenatal care at Massachusetts General Hospital were retrospectively identified and charts reviewed. The primary outcome was adherence to the American Association for the Study of Liver Diseases (AASLD) and American College of Obstetricians and Gynecologists guidelines. Over one-third (37%) of women were first diagnosed with HBV infection at a prenatal visit. One-third (32%) did not undergo timely liver function test measurements. HBV DNA was never measured in 26% and was untimely in 34% of patients. One-third (34%) of the women were at high-risk for HCC based on AASLD criteria, yet only 33% of these women underwent timely imaging. Nearly half (49%) never saw a liver specialist for their HBV care. In multivariate analysis, women were 3.7 times more likely to have a timely ALT and 8.1 times more likely to have a timely HBV DNA if they were followed by a liver specialist (P = 0.001, <0.001). We demonstrate remarkably inadequate and discontinuous HBV care for chronically infected mothers following pregnancy. As HBV infection is already being identified prenatally, quality improvement measures encompassing obstetricians, primary care providers and hepatologists are needed to ensure that HBV-infected women are linked to care postpregnancy.
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Affiliation(s)
- R Rajbhandari
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - K Barton
- Bureau of Infectious Disease, Massachusetts Department of Public Health, Hinton State Laboratory Institute, Jamaica Plain, MA, USA
| | - A C Juncadella
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - A K Rubin
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - T Ajayi
- Department of Medicine, Salem Hospital, Salem, MA, USA
| | - Y Wu
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - A N Ananthakrishnan
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - R T Chung
- Gastroenterology Division, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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14
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Fuster F, Vargas JI, Jensen D, Sarmiento V, Acuña P, Peirano F, Fuster F, Arab JP, Martínez F. CD4/CD8 ratio as a predictor of the response to HBV vaccination in HIV-positive patients: A prospective cohort study. Vaccine 2016; 34:1889-95. [PMID: 26945101 DOI: 10.1016/j.vaccine.2016.02.055] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share transmission mechanisms and thus coinfection is frequent. Active immunization against HBV is essential in HIV patients. Reports using standard and reinforced HBV vaccination schedules vary widely in seroconversion rates depending on the characteristics of the included patients. Regional data concerning HBV vaccination in HIV patients are scarce. We aim to determine the serological response to HBV vaccination using standard schedule in HIV-positive patients and to evaluate characteristics that predict seroconversion. MATERIALS AND METHODS We performed a single centre prospective study of HBV vaccination with standard schedule in HIV-positive patients. Adults with negative markers of HBV infection were included between November 2012 and December 2014. Anti-HBs titres were measured 4-8 weeks after completion of vaccination schedule. Clinical, laboratory values and HIV characteristics were analyzed to determine their association with seroconversion and adherence to the HBV vaccination schedule. RESULTS The study included 245 HIV-positive patients, 68.9% were male and the mean age was 42.1 years. A total of 80.7% of the patients had undetectable HIV viral loads, 86.1% had CD4 counts >200, and 94.7% were on HAART. The response to vaccination was positive in 62% (95% CI, 56-68%) and mean anti-HBs titres of 646 IU/ml. 85.5% of the responders had anti-HBs titres >100 IU/ml. An age less than 45 years, no tobacco use and a CD4/CD8 ratio >0.4 were associated with seroconversion in multivariate analysis. The seroconversion rates were 86% in the subgroup of patients who met these criteria. A total of 97.9% of the study population completed the vaccination schedule. CONCLUSION The CD4/CD8 ratio was the primary factor associated with positive serological conversion in the multivariate analysis. The seroconversion rates were higher in a selected group of patients who were particularly suitable for the use of the standard HBV vaccination schedule.
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Affiliation(s)
| | - Jose Ignacio Vargas
- Unidad de Hepatología, Hospital Gustavo Fricke, Chile; Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile; Servicio de Medicina Interna, Hospital Naval Almirante Nef, Chile.
| | - Daniela Jensen
- Servicio de Medicina Interna, Hospital Naval Almirante Nef, Chile; Escuela de Medicina, Universidad de Valparaíso, Chile
| | | | - Pedro Acuña
- Escuela de Medicina, Universidad Andrés Bello, Chile
| | | | - Felipe Fuster
- Escuela de Medicina, Universidad Del Desarrollo, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Felipe Martínez
- Departamento de Salud Pública, Escuela de Medicina, Universidad de Valparaíso, Chile; Área de Investigación y Estudios Clínicos, Clínica Ciudad del Mar, Chile
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15
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Bottecchia M, Barcaiu HS, Lewis-Ximenez LL, da Silva E Mouta Junior S, de Moraes MTB. Monitoring the emergence of HBV resistance mutations by HBV-RNA pyrosequencing. Braz J Infect Dis 2016; 20:216-7. [PMID: 26748231 PMCID: PMC9427611 DOI: 10.1016/j.bjid.2015.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 01/20/2023] Open
Affiliation(s)
- Marcelle Bottecchia
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Halime Silva Barcaiu
- DIP Doenças Infecto-parasitárias, Hospital dos Servidores do Estado (HSE), Rio de Janeiro, RJ, Brazil
| | - Lia Laura Lewis-Ximenez
- Laboratório de Hepatites Virais, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Sergio da Silva E Mouta Junior
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Marcia Terezinha Baroni de Moraes
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
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16
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Vargas JI, Jensen D, Sarmiento V, Peirano F, Acuña P, Fuster F, Soto S, Ahumada R, Huilcaman M, Bruna M, Jensen W, Fuster F. Presence of anti-HBc is associated to high rates of HBV resolved infection and low threshold for Occult HBV Infection in HIV patients with negative HBsAg in Chile. J Med Virol 2015; 88:639-46. [PMID: 26381185 DOI: 10.1002/jmv.24384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/30/2022]
Abstract
HBV-HIV coinfection is prevalent. Frequently, anti-HBc is the only serological marker of HBV, which can be indicative of HBV resolved infection, when found together with anti-HBs reactivity; or present as "isolated anti-HBc," related to HBV occult infection with presence of detectable DNA HBV, more prevalent in HIV-positive individuals. Regional data about this condition are scarce. Anti-HBc rapid test has been used as screening, but its performance has not been described in HIV-positive patients. The aim of this study was determine prevalence of anti-HBc in HIV-positive patients, serological pattern of HBV resolved infection and isolated anti-HBc, evaluating presence of HBV occult infection. Assess anti-HBc rapid test compared to ECLIA. Methods included measurement of anti-HBc and anti-HBs in HIV-positive patients with negative HBsAg. Serum HBV DNA quantification and HBV booster vaccination to "isolated anti-HBc" individuals. Detection of anti-HBc by rapid test and ECLIA. In 192 patients, prevalence of anti-HBc was 42.7% (82/192); associated to male gender, drug use, men-sex-men, positive-VDRL, and longer time HIV diagnosis. 34.4% (66/192) had presence of anti-HBs, mean titers of 637 ui/ml. Isolated anti-HBc in 8.3% (16/192), associated to detectable HIV viral load and no-use of HAART; in them, HBV DNA was undetectable, and 60% responded to HBV vaccination booster. Anti-HBc rapid test showed low sensibility (32.9%) compared to ECLIA. These results show that prevalence of anti-HBc in HIV-positive individuals is high, in most cases accompanied with anti-HBs as HBV resolved infection. Low prevalence of "isolated anti-HBc," with undetectable HBV DNA, and most had anamnestic response to HBV vaccination; suggest low possibility of occult HBV infection. Anti-HBc rapid test cannot be recommended as screening method for anti-HBc.
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Affiliation(s)
- Jose Ignacio Vargas
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Servicio de Medicina Interna, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Daniela Jensen
- Servicio de Medicina Interna, Hospital Naval Almirante Nef, Viña del Mar, Chile.,Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Valeska Sarmiento
- Unidad de Hepatología, Hospital Gustavo Fricke, Viña del Mar, Chile.,Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Felipe Peirano
- Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Pedro Acuña
- Escuela de Medicina, Universidad Andrés Bello, Viña del Mar, Chile
| | - Felipe Fuster
- Escuela de Medicina, Universidad Del Desarrollo, Santiago, Chile
| | | | - Rodrigo Ahumada
- Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Marco Huilcaman
- Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Mario Bruna
- Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Werner Jensen
- Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile.,Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Francisco Fuster
- Unidad de Hepatología, Hospital Gustavo Fricke, Viña del Mar, Chile
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17
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Abstract
In HIV-infected individuals, coinfection with HBV and/or HCV is common because of shared modes of transmission. It is known that HIV accelerates progression of liver disease and results in increased morbidity and mortality associated with viral hepatitis, but it is less clear if viral hepatitis has a direct effect on HIV. Treatment of viral hepatitis improves outcomes and should be considered in all HIV-infected patients. Treatment of HBV without concurrent treatment of HIV is risky because resistance can occur in both viruses if regimens are not carefully chosen.
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18
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Mena G, Vilajeliu A, Urbiztondo L, Bayas JM. [Regional recommendations on hepatitis vaccination in human immunodeficiency virus infected adult patients in Spain: Evidence-based disparity?]. Med Clin (Barc) 2015; 145:163-70. [PMID: 25771339 DOI: 10.1016/j.medcli.2014.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/17/2014] [Accepted: 12/20/2014] [Indexed: 01/18/2023]
Affiliation(s)
- Guillermo Mena
- Servicio de Medicina Preventiva y Calidad Asistencial, Hospital General Universitari de Castelló, Castelló de la Plana, España
| | - Alba Vilajeliu
- Servicio de Medicina Preventiva y Epidemiología ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, España
| | - Luis Urbiztondo
- Agència de Salut Pública de Catalunya, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - José M Bayas
- Servicio de Medicina Preventiva y Epidemiología ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, España.
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19
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Fernández-Montero JV, Vispo E, Barreiro P, Sierra-Enguita R, de Mendoza C, Labarga P, Soriano V. Hepatitis delta is a major determinant of liver decompensation events and death in HIV-infected patients. Clin Infect Dis 2014; 58:1549-53. [PMID: 24633686 DOI: 10.1093/cid/ciu167] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Coinfection with hepatitis viruses is common in individuals infected with human immunodeficiency virus (HIV) and has become a leading cause of complications and death in those receiving antiretroviral therapy (ART). METHODS We retrospectively examined the effect of coinfection with hepatitis B, C, and/or D viruses (HBV, HCV, HDV, respectively) on liver decompensation events (ascites, variceal bleeding, encephalopathy, and/or hepatocellular carcinoma) and liver-related mortality in HIV-positive patients on regular follow-up since the year 2004 at a reference HIV clinic in Madrid, Spain. RESULTS A total of 1147 HIV-infected patients (mean age, 42 years; 81% males; 46% intravenous drug users, 85.4% on ART) were analyzed. Mean follow-up was 81.2 ± 17.8 months. At baseline, 521 patients (45.4%) were HCV-antibody positive, 85 (7.4%) were hepatitis B surface antigen positive, and 17 (1.5%) were anti-HDV positive. A total of 233 HIV/HCV-coinfected patients received antiviral therapy for HCV, of whom 106 (45%) achieved sustained virologic response (SVR). Overall, 15 patients died of liver-related complications and 26 developed hepatic decompensation events. Taking as controls the 524 HIV-monoinfected patients, HDV coinfection (adjusted hazard ratio [AHR], 7.5; 95% confidence interval [CI], 1.84-30.8; P = .005) and baseline liver stiffness (AHR, 1.1; 95% CI, 1.07-1.13; P < .0001) were associated with a higher rate of liver-related morbidity and mortality. In contrast, SVR following hepatitis C therapy in HIV/HCV-coinfected patients was protective (AHR, 0.11; 95% CI, .01-.86; P = .03). CONCLUSIONS Hepatitis delta is associated with a high rate of death and liver decompensation events in HIV-infected patients on ART.
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20
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Stosor V. Organ Transplantation in HIV Patients: Current Status and New Directions. Curr Infect Dis Rep 2013; 15:526-35. [PMID: 24142801 DOI: 10.1007/s11908-013-0381-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Combination antiretroviral therapy has resulted in longer life expectancies in persons living with HIV; however, end organ disease and death from organ failure have become growing issues for this population. With effective therapies for viral suppression, HIV is no longer considered an absolute contraindication to organ transplantation. Over the past decade, studies of transplantation in patients with HIV have had encouraging results such that patients with organ failure are pursuing transplantation. This review focuses on the current status of organ transplantation for HIV-infected persons.
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Affiliation(s)
- Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL, 60611, USA,
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