Byrne DD, Newcomb CW, Carbonari DM et al. It is recommended that all women initiating therapy for the first time or those receiving therapy who have a detectable viral load undergo genotypic resistance testing to guide therapy selection. • Fib-4 showed that 8 of 24 patients with non-A genotypes had advanced fibrosis, compared to 9 of 68 genotype A patients (33% vs 13%; P = 0.03). Incidence was higher in those HBsAg+ve (5.8% vs 1.0%, p< 0.001) and those receiving NVP (2.7% vs 1.1%, p=0.017). Military HIV Natural History Study (NHS) is a prospective multicenter continuous enrollment observational cohort of HIV-infected active duty military personnel and other beneficiaries (spouses, adult dependents, and retired military personnel), with over 5400 HIV-infected participants from the Army, Navy/Marines and Air Force enrolled since 1986. The authors conclude that effective HAART was associated with reduced rates of incident HBV infection in HIV-infected men but warn that HBV infection rates remain high even among HIV-uninfected MSM or MSM with well-controlled HIV. Because that cultural aversion to hepatitis B testing and management is due largely to a lack of knowledge about routes of HBV transmission and means of prevention, any effort to deliver viral-hepatitis services to the foreign-born population must include an educational component to dispel myths (for example, that HBV can be transmitted through food, water, and casual contact) and to establish facts, particularly ones that encourage testing, vaccination, and followup. HIV/HBV-coinfected patients with at least 24 weeks of prior lamivudine treatment and rebound HBV viremia were randomized to the addition of entecavir 1.0 mg (n = 51) or placebo (n = 17). Pietra, S. Disease progresses if therapy is halted. With adults, the risk of developing chronic HBV infection depends on the health of the immune system. Because HBV DNA can persist in the liver indefinitely, persons with cAb positivity are at risk of HBV reactivation even if they test positive for sAb, particularly if they become severely immunosuppressed (see Table 1 and Figure 2). A woman who is infected with HBV can also pass HBV to her newborn. Therefore, when used in HBV/HIV-coinfected patients, entecavir must be used in addition to a fully suppressive ARV regimen (AII).9 When 3TC is the only active drug used to treat chronic HBV in HBV/HIV coinfected patients, 3TC-resistant HBV emerges in approximately 40% and 90% of patients after 2 and 4 years on 3TC, respectively.
Since publication of the 1998 HIV exposure guidelines (5), several new antiretroviral agents have been approved by the Food and Drug Administration (FDA), and more information is available about the use and safety of HIV PEP (6–11). The three-dose HBV vaccine series is given at 0, 1 to 2 months, and 6 months. There is a decreased likelihood of HBV clearance through a broad cellular response in HIV-infected persons with lower CD4+ T cell counts, compared with HIV-infected persons with higher CD4+ cell counts, at the time of HBV acquisition. J Infect Dis 1999; 180:607-613. However, the official number of reported Hepatitis B cases is much lower. Transfusion-associated infection is now rare in the UK, as blood donations are screened. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV-positive patients is therefore recommended before commencement of HAART.
The increased rate of death among coinfected individuals was observed in the meta-analyses of studies conducted both before (pooled effect estimate, 1.60; 95% confidence interval, 1.07–2.39) and after (pooled effect estimate, 1.28; 95% confidence interval, 1.03–1.60) commencement of highly active antiretroviral therapy. Hepatic histology was available for 832 participants in this trial. Of the 246 women and girls in the study, 74 (30.1%, ≈1 in 3) had positive HIV test results. In HIV patients, the concurrent infection with HBV has been recognized to lead to increased tendency for the occurrence of AIDS-related and non-AIDS-related clinical outcomes, such as end-stage liver diseases including cirrhosis and HCC [38, 39]. Sexual transmission of hepatitis C is less common, but it does occur. HBV DNA was detected and quantified by real time-PCR amplification followed by HBV genotype determination. HBsAg levels correlated with CD4 T-cell count and were higher in patients with more advanced HIV CDC stage.
Most importantly, the results also partly mirror HBsAg positivity rates of 7 % in HIV-1 infected female sex workers from Mombasa (the same region as the current study area) . To date, 3 cases of transmission of HIV and 8 confirmed cases of transmission of HCV (to a total of 18 patients) from infected healthcare workers to patients have been reported. We tested for HBsAg and followed up HBsAg-positive samples by testing for HBeAg, HBV DNA, HBV genotype, presence of drug-resistance associated mutations (RAMs) and HDV. During the period 1997–2002, a total of 633 HIV-infected patients were tested for HBV serological markers at baseline, including hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs ), antibody to hepatitis B core antigen (anti-HBc), hepatitis C virus (HCV) antibody (anti-HCV) antibody, HCV RNA level, and HBV DNA level, all of which were retested at least 1 year apart.