Hepatitis B Virus and HIV Coinfection in Low-Income Countries: Unmet Needs

Abstract

Approximately 350 million people (5%-7% of the worlds population) are chronically infected with the hepatitis B virus (HBV) and 600000 (0.2%) die each year of HBV-related disease and hepatocellular carcinoma. Sub-Saharan Africa and the Far East have high HBV endemicity (population prevalence 18%); Eastern and Southern Europe South America and the rest of Africa and Asia have intermediate endemicity (population prevalence 2%-8%); northern Europe North America and Australia have low endemicity (population prevalence !2%). It is estimated that worldwide 40 million people live with HIV infection and that 3 million (7.5%) of them die of HIV-related tumors and opportunistic infections. This striking difference in mortality between those with HIV infection and those with chronic HBV infection can explain why treatment of HIV infection has a priority over HBV treatment to reduce mortality both in the general population and in the single coinfected patient. In low-endemicity areas most HBV infections occur in adolescents and young adults and the majority of infections are acquired sexually or through percutaneous exposure. Thus HBV and HIV share common transmission pathways in these areas and the prevalence of hepatitis B surface antigen (HBsAg) reactivity in HIV-coinfected patients is 5%-10% 2.5-10 times the population prevalence. (excerpt)