Abstract
There is overwhelming evidence of a strong association between human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infections in areas of low endemicity for both viruses, due to shared risk factors. There is also much evidence that HIV modifies the natural history of HBV infection in these areas: co-infected individuals are more likely to be HBV chronic carriers, with higher levels of HBV infectivity, than HIV-negative individuals. Also, immunosuppression brought about by HIV infection reduces persistence of anti-HBs in previously immune and vaccinated individuals, and can cause HBV reactivation or re-infection in those previously exposed to HBV. Furthermore, HIV infection increases the risk of death from liver disease in HBV co-infected individuals, and this risk increases when these patients are treated with highly active anti-retroviral therapy. However, extensive research has found no convincing evidence that HBV impacts on the transmission and natural history of HIV infection. However, the...
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