Human Immunodeficiency Virus and Hepatitis B Virus Co-infection in Pregnancy: A Review.

British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review).

Top of page Abstract Introduction 1.0 Summary of recommendations 2.0 Scenarios: interventions to reduce mother-to child transmission of HIV 3.0 Background: UK prevalence of HIV in pregnancy and risk of transmission 4.0 Antenatal HIV testing 5.0 Preconception and fertility management in men and women infected with HIV 6.0 Sexual health of HIV-positive pregnant women 7.0 Psychosocial issues 8.0 Viral load and resistance 9.0 Management of HIV-related complications in pregnancy 10.0 Antiretroviral therapy in pregnancy: efficacy 11.0 Antiretroviral therapy in pregnancy: toxicity 12.0 Antiretroviral therapy and pregnancy: pharmacokinetics 13.0 Obstetric management of pregnancy and delivery 14.0 Pregnancy in women with HIV-2 infection 15.0 HIV and hepatitis B and C coinfections 16.0 Management of infants born to HIV-infected mothers 17.0 Infant feeding and HIV transmission during breastfeeding References Appendix

Co-infection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) represents a complex and dispassionate challenge that demands a versatile approach. This abstract specifies a survey of key strategies for the administration of HBV/ HIV co-contamination, accompanied by a devoted effort to antiretroviral healing (ART), the HBV situation, and listening. Antiretroviral therapy is the foundation for directing hepatitis B virus (HBV)/HIV contamination. The incorporation of HIVHBV drugs into ART regimens is essential. Tenofovir-located regimens containing tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) have proven to be effective against both viruses. Emtricitabine and lamivudine are frequently used in combination medicine. Monitoring drug opposition and energy abolition is achieved by guaranteeing the influence of the treatment. In HBV mono-infection, nucleotide analogs (NA) are used to restrain energetic copies. However, in cocontamination, NAs concede the possibility of ideally having a two-fold project against both HIV and HBV infection. TDF and TAF meet this necessity, making the ruling class the chosen choice. Regular listening is essential for evaluating the reaction to the situation and the progress of a liver ailment. This involves measuring the CD4 counts, HIV RNA levels, and HBV DNA levels. In addition, liver function tests and liver depictions help label cirrhosis and abnormal hepatocellular growth in animals. HBV immunization is essential for co-infected cells that are not resistant to HBV. Post-vaccination agents that negate the effect of an infection or poison titer should be restrained to ratify exemption. The prevention of broadcasting is another critical aspect of the administration. Safe sexuality practices and harm decline methods, including tease exchange programs for injecting drug use, detract from lowering the risk of transmission of the two viruses together.

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection is highest in sub-Saharan Africa and results in accelerated clinical outcomes compared with HBV or HIV mono-infection. HBV clearance rates are higher in healthy adults; however, in sub-Saharan Africa, there are limited data on clearance of incident HBV in HIV-infected adults. Therefore, we sought to estimate HBV incidence and HBV surface antigen (HBsAg) clearance in HIV-infected adults in Botswana.This was a retrospective longitudinal study of 442 HIV-1C infected treatment naïve patients enrolled in a previous Botswana Harvard AIDS Institute Partnership study. Archived plasma samples from 435 HIV-infected treatment naïve participants were screened for HBsAg and HBV core antibody (anti-HBc). HBsAg was evaluated annually over a 4-year period, and HBV deoxyribonucleic acid (DNA) levels of HBsAg-positive chronic and incident patients were quantified.Baseline median CD4+ T-cell count was 458 cells/μL [Q1, Q3: 373, 593], and median HIV viral load was 4.15 copies/mL [Q1, Q3: 3.46, 4.64]. Twenty two HBV incident cases occurred, representing an incidence of 3.6/100 person-years [95% CI: 2.2–5.6]. All incident HBV cases with a follow-up sample available for screening (13/22) cleared HBsAg. Detectable HBV viral loads among chronic and incident cases ranged between 5.15 × 101 to 1.4 × 107 IU/L and 1.80 × 101 to 1.7 × 108 IU/mL, respectively.We report high HBV incidence associated with elevated HBV DNA levels despite high CD4+ T-cell counts in HIV-infected patients in Botswana. These incidence cases represent a potential source of HBV transmission in the population. Scaling-up of HIV treatment strategies utilizing antiretroviral therapy regimens with anti-HBV activity coupled with screening for HBV infections in households of the HBsAg-positive cases is recommended.

Purpose: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) , hepatitis C virus are causes of significant morbidity and mortality across the World .HIV and HBV&HCV are blood-borne viruses transmitted usually through sexual contact and use of unsterilized needles. Their similar means of transmission increases the risk of contracting both infections concurrently. This study was aimed at assessing the knowledge, practices and attitude of pregnant women on prevention and transmission of HIV, hepatitis B and C with respect to educational level at the Mifi health district. Methodology: This study was a descriptive cross sectional study involving pregnant women who visited different health centers with the Mifi health district between the month of January to june 2023. Sampling was done by convenience Data was analysed using version 20.0. and the data was presented in tables and bar graphs, meanwhile the pearson chi square test was used to compare variables under investigation at a confidence interval of 95%, providing a 5% error margin. Descriptive values were expressed as the frequency, percentage, and mean ± standard deviation (SD). Findings: Out of the 467 participants, 80.73% were within the poor knowledge range whereas 12.63% showed good knowledge (while 6.63 recorded excellent knowledge scores. 44.96% were within the poor practice range while 55.03% showed good practice. majority showed poor attitude toward transmission and prevention of HIV, HBV and HCV as only 18(3.85%) were willing to meet the doctor if they were diagnosed of any of the above mention infections meaning 449 (96.14%) will embrace fear and sadness. Majority of pregnant women in this study had good knowledge regarding prevention and transmission of HIV,HBV and. Irrespective of the knowledge, practices and attitude of the participants were generally poor at the Mifi health district in Cameroon. Unique Contribution to Theory, Practice and Policy: This research have come to set standard in health facilities in the mifi health district by proving beyond doubt that pregnant women are co infected with both HIV,HBV, and HCV and giving the poor attitude and practices among women that fuel the transmissions of these infections, we stand to advocate that all women presenting for ANC, should be compulsorily tested for HIV,HBV and HCV and equally much education on the transmission mode of these infections by the nurses should be implemented. This study have saved as an eye opener to policy makers to impost the testing of HIV, HBV and HCV during every first ANC visit and possibly two weeks before delivery.

The incidence of hepatitis B virus (HBV) infection in dialysis populations has declined over recent decades, largely because of improvements in infection control and widespread implementation of HBV vaccination. Regardless, outbreaks of infection continue to occur in dialysis units, and prevalence rates remain unacceptably high. For a variety of reasons, dialysis patients are at increased risk of acquiring HBV. They also demonstrate different disease manifestations compared with healthy individuals and are more likely to progress to chronic carriage. This paper will review the epidemiology, modes of transmission and diagnosis of HBV in this population. Prevention and treatment will be discussed, with a specific focus on strategies to improve vaccination response, new therapeutic options and selection of patients for therapy.

Enhancing current human immunodeficiency virus/hepatitis B and human immunodeficiency virus/hepatitis C virus co-infection management.

BackgroundHepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections are associated with significant mortality globally and in North America. However, data on impact of concurrent multiple infections on mortality risk are limited. We evaluated the effect of HCV, HBV, and HIV infections and coinfections and associated factors on all-cause mortality in British Columbia (BC), Canada.MethodsThe BC Hepatitis Testers Cohort includes ~1.7 million individuals tested for HCV or HIV, or reported as a case of HCV, HIV, or HBV from 1990 to 2015, linked to administrative databases. We followed people with HCV, HBV, or HIV monoinfection, coinfections, and triple infections from their negative status to date of death or December 31, 2016. Extended Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for factors associated with all-cause mortality.ResultsOf 658 704 individuals tested for HCV, HBV, and HIV, there were 33 804 (5.13%) deaths. In multivariable Cox regression analysis, individuals with HCV/HBV/HIV (HR, 8.9; 95% CI, 8.2–9.7) infections had the highest risk of mortality followed by HCV/HIV (HR, 4.8; 95% CI, 4.4–5.1), HBV/HIV (HR, 4.1; 95% CI, 3.5–4.8), HCV/HBV (HR, 3.9; 95% CI, 3.7–4.2), HCV (HR, 2.6; 95% CI, 2.6–2.7), HBV (HR, 2.2; 95% CI, 2.0–2.3), and HIV (HR, 1.6; 95% CI, 1.5–1.7). Additional factors associated with mortality included injection drug use, problematic alcohol use, material deprivation, diabetes, chronic kidney disease, heart failure, and hypertension.ConclusionsConcurrent multiple infections are associated with high mortality risk. Substance use, comorbidities, and material disadvantage were significantly associated with mortality independent of coinfection. Preventive interventions, including harm reduction combined with coinfection treatments, can significantly reduce mortality.

Hepatitis B virus traceback and lookback: factors to consider

Hepatitis viruses and human immunodeficiency virus co-infection: pathogenisis and treatment

Hepatitis B virus (HBV) and its vaccination strategy may affect human immunodeficiency virus (HIV) transmission dynamics because both viruses have synergistic effects. To quantitatively assess the potential impact of HBV and its vaccination strategy on HIV transmission dynamics at the population level, in this paper, we formulate a deterministic compartmental model that describes the joint dynamics of HBV and HIV. We first derive the explicit expressions for the basic reproduction numbers of HIV and HBV and analyze the dynamics of HIV and HBV subsystems, respectively. Then a systematic qualitative analysis of the full system is also provided, which includes the local and global behavior. By using a set of reasonable parameter values, the full system is numerically investigated to assess the potential impact of HBV and its vaccination strategy on HIV transmission. The direct and indirect population level impact of HBV on HIV is demonstrated by calculating the fraction of HIV infections attributable to HBV and the difference between HIV prevalence in the presence and absence of HBV, respectively. The findings imply that the increase of HBV vaccination rate may unusually accelerate HIV epidemics indirectly, although the direct effect of HBV on HIV transmission decreases as HBV vaccination rate increases. Finally, the potential impact of HIV on HBV transmission dynamics is investigated by way of parenthesis. Copyright © 2016 John Wiley & Sons, Ltd.

Preventing Infection-Associated Cancer: From Bench to Hillside

In April 2018, Ottawa Public Health identified a large-scale infection prevention and control (IPAC) lapse spanning 15 years related to inadequate reprocessing of reusable critical medical equipment used in a family medicine clinic. To describe the public health response to, and estimate the risk of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission from, this IPAC lapse. Patients who underwent a procedure of concern (during which reusable equipment may have been used) at this clinic were identified using Ontario Health Insurance Plan data and individually notified. Testing for HBV, HCV and HIV at the Public Health Ontario Laboratory was recommended, and the odds of infection were estimated. Of 4,495 patients possibly exposed to improperly reprocessed equipment, 1,496 (33.3%) underwent testing within six months of notification. The prevalence of HBV, HCV and HIV infection in this group was lower than in the general Canadian population. Among patients first diagnosed with HBV after a procedure of concern, the odds of HBV transmission were not increased when the procedure occurred within seven or 28 days of another patient with a positive HBV test result (OR7 days, age-adjusted=0.59, 95% CI: 0.14-2.51; OR28 days, age-adjusted=1.35, 95% CI: 0.62-2.93). The odds of HCV and HIV transmission could not be estimated because no patient was diagnosed with HCV or HIV after having a procedure of concern within 28 days of another patient with a positive HCV or HIV test result. We found no evidence of HBV, HCV or HIV transmission associated with this IPAC lapse. However, transmission cannot be ruled out conclusively because only a third of possibly exposed patients underwent testing.

Despite dramatic reductions in perinatal human immunodeficiency virus (HIV) transmission in the United States, obstacles to perinatal HIV prevention that include lack of prenatal care; failure to test pregnant women for HIV before delivery; and lack of prenatal, intrapartum, or neonatal antiretroviral (ARV) use remain. The objective of this study was to describe trends in perinatal HIV prevention methods, perinatal transmission rates, and the contribution of missed opportunities for perinatal HIV prevention to perinatal HIV infection. We analyzed data obtained from infant medical records on 4755 HIV-exposed singleton deliveries in 1996-2000, from 6 US sites that participate in the Centers for Disease Control and Prevention's Pediatric Spectrum of HIV Disease Project. HIV-exposed deliveries refer to deliveries in which the mother was known to have HIV infection during the pregnancy. Of the 4287 women with data on prenatal care, 92% had prenatal care. From 1996 to 2000, among the 3925 women with prenatal care, 92% had an HIV test before delivery; the use of prenatal zidovudine (ZDV) alone decreased from 71% to 9%, and the use of prenatal ZDV with other ARVs increased from 6% to 70%. Complete data on maternal and neonatal ARVs were available for 3284 deliveries. Perinatal HIV transmission was 3% in 1651 deliveries with prenatal ZDV in combination with other ARVs, intrapartum ZDV, and neonatal ZDV; 6% in 1111 deliveries with prenatal, intrapartum, and neonatal ZDV alone; 8% in 152 deliveries with intrapartum and neonatal ZDV alone; 14% of 73 deliveries with neonatal ZDV only started within 24 hours of birth; and 20% in 297 deliveries with no prenatal, intrapartum, and neonatal ARVs. Complete data on prenatal events were available in 328 HIV-infected and 3258 HIV-uninfected infants. A total of 56% of mothers of HIV-infected infants had missed opportunities for perinatal HIV prevention versus 16% of mothers of HIV-uninfected infants. Forty-four percent of the infected infants were born to mothers who had prenatal care, a prenatal HIV diagnosis, and documented prenatal ARV therapy. Seventeen percent of women with reported illicit drug use had no prenatal care versus 3% of women with no reported drug use. In a multivariate analysis, maternal illicit drug use was significantly associated with lack of prenatal care. In a multivariate analysis, year of infant birth and the combination of lack of maternal HIV testing before delivery and lack of prenatal antiretroviral therapies were significantly associated with perinatal HIV transmission. Missed opportunities for perinatal HIV prevention contributed to more than half of the cases of HIV-infected infants. Prenatal care and HIV testing before delivery are major opportunities for perinatal HIV prevention. Illicit drug use was highly associated with lack of prenatal care, and lack of HIV testing before delivery was highly associated with perinatal HIV transmission.

People with human immunodeficiency virus-hepatitis B virus (HIV-HBV) co-infection have faster rates of liver disease progression and an increase in hepatocellular carcinoma compared to people with HBV mono-infection. Given that HIV can infect multiple cells in the liver, including hepatocytes, we hypothesized that HIV will impact HBV replication through HIV viral proteins that can impact HBV replication either directly or indirectly, via effects on cellular pathways. Following infection of sodium taurocholate co-transporting polypeptide (NTCP)-expressing HepG2 cells with HBV and vesicular stomatitis virus G protein (VSV.G)-pseudotyped HIV, we found that productive HIV infection led to a twofold upregulation of HBV surface (HBs) mRNA and a marked increase in intracellular production and cellular retention of HBs antigen (HBsAg). Overexpression of HIV Tat protein, but not other HIV proteins, by DNA plasmid transfection in the HBV-producing cell line AD38 significantly stimulated HBs mRNA expression. This could be rescued by CDK9 inhibition with BAY-1251152. This study provides new insights into the mechanisms by which HIV directly impacts HBV replication and has implications for understanding adverse liver outcomes in people living with HIV and HBV.IMPORTANCEPeople with both human immunodeficiency virus (HIV) and hepatitis B virus (HBV) face faster liver disease progression and a higher risk of liver cancer than those with HBV alone. This study investigated how HIV affects HBV replication in liver cells and found that HIV infection increases the production of a key HBV surface protein (HBsAg) by enhancing the expression of its gene (HBs). This effect is driven by the HIV Tat protein. Notably, blocking the CDK9 pathway prevented this increase, suggesting a possible explanation for the adverse liver outcomes in co-infected individuals. Our findings have implications for interventions aiming to cure HIV through latency reversal, as these interventions can specifically increase the Tat protein. Future exploratory treatment strategies, such as Tat inhibitors, could play a role in the management of people with HIV and HBV at high risk of liver disease.