Infection in people who inject drugs (PWID) or men who have sex with men (MSM) drives HIV epidemics in many countries in the WHO European Region. These populations also report a high prevalence of co-infection with hepatitis B or C due to the same modes of transmission – unprotected sexual intercourse and sharing of injecting equipment.
HIV accelerates the course of liver disease associated with hepatitis C virus (HCV), particularly in patients who are more severely immune deficient.
- Patients co-infected with HCV/HIV have a more rapid fibrosis progression than HCV mono-infected patients. They are also more likely to have quantitative and/or qualitative deficiencies in their immune responses to HCV, resulting in a significant decrease in spontaneous clearance.
- The risk of mother-to-child and sexual transmission increases on average from 6% to 20% and from 0% to 3%, respectively in patients co-infected with HCV/HIV.
- Liver failure in HIV/HCV co-infected patients is one of several top causes of death.
HIV accelerates hepatitis B virus (HBV) disease progression.
- HBV infection is more severe in people co-infected with HIV.
- Higher HBV replication results in more severe liver fibrosis with increased risk (4.2 times greater) for cirrhosis and a faster progression to end-stage liver disease.
- In HIV/HBV co-infected patients with cirrhosis, hepatocellular carcinoma (HCC) may appear more aggressive and at earlier age.
- HIV appears to be a risk factor for reactivation of hepatitis B in patients who have developed hepatitis B surface antibody (HBsAb).
- Co-infected patients have an increased risk of liver-related mortality.
New WHO guidelines on antiretroviral therapy for HIV include recommendations on management of patients co-infected with hepatitis B.