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Year : 2003  |  Volume : 21  |  Issue : 2  |  Page : 141--142

Co-infection with Hepatitis B and human immunodeficiency viruses in patients of liver disease

A Kumar, I Shukla, A Malik 
 Department of Microbiology, JN Medical College, AMU, Aligarh - 202 002, UP, India

Correspondence Address:
A Kumar
Department of Microbiology, JN Medical College, AMU, Aligarh - 202 002, UP
India

How to cite this article:
Kumar A, Shukla I, Malik A. Co-infection with Hepatitis B and human immunodeficiency viruses in patients of liver disease.Indian J Med Microbiol 2003;21:141-142

How to cite this URL:
Kumar A, Shukla I, Malik A. Co-infection with Hepatitis B and human immunodeficiency viruses in patients of liver disease. Indian J Med Microbiol [serial online] 2003 [cited 2020 Jan 20 ];21:141-142
Available from: http://www.ijmm.org/text.asp?2003/21/2/141/7997

Full Text

Dear Editor,

The modes of transmission of HBV and HIV are similar being transmitted overtly by blood transfusions and covertly by percutaneous routes. The course of hepatitis B virus infection is modified by the presence of HIV. In most of the patients with HIV and HBV coinfection, it is impossible to determine the relative timing of the two viral exposures. We report here the prevalence of HBV/HIV coinfection among liver disease patients from April 1999 to May 2000.

A total of 888 patients (546 males and 342 females) who presented with acute or chronic hepatitis, hepatic encephalopathy or cirrhosis of liver were included in the study. Five millilitres of blood was collected aseptically from all patients. Serum was separated and preserved at -20C. All 888 test serum samples were subjected to latex agglutination test and the positive samples were further confirmed by ELISA for HBsAg. All HBV positive sera were screened for the presence of anti- HIV (1 and 2) antibodies following the ERS protocol.

One hundred and eighty two test sera were HBsAg positive by the latex agglutination test and on further confirmation by ELISA test, only 154 (17.34%) sera were found to be positive (111males and 43 females). Most of these patients were above the age of 20 years. In the study group 46.75 % patients presented with acute viral hepatitis (AVH), 29.22% with chronic viral hepatitis (CVH), 12.98% with cirrhosis of liver and only 11.03% with hepatic encephalopathy (HE). Only 4 (2.59%) HBsAg positive patients (3 males and 1 female) were detected to be coinfected with HIV and all of these were found suffering with chronic viral hepatitis. Two males were young adults in the age group of 21-30 years and one male and one female patient were in the age group of 41-50 years. All four HBV/HIV coinfected patients gave positive histories of reusable needle pricks, two patients gave previous history of contact with sex workers and one patient of undergoing a major surgery and blood transfusion. The female patient had acquired probably the infection from her infected spouse. The biochemical parameters among these four co-infected patients were mostly within the normal range. ALT, AST and total serum bilirubin levels were found to be elevated in one HBV/HIV coinfected male patient (aged 45 years), while another male patient (aged 30 years) had raised ALT level only. Three of the HBV/HIV co-infected patients expired within 10 weeks of diagnosis and the fate of one was not known.

HBsAg antigenemia among liver disease patients was 17.34% which is in concordance with findings of other workers in India, with a HBsAg detection rate varying between 12.2-51%.[1] In our study, the prevalence of HIV infection in HBV infected patients was found to be low (2.59%) compared to the percentage of coinfection from 28% to 85% as reported by various workers.[2] This may be due to a lesser number of HIV seropositives in this part of northern India. Chronic carriage of HBV only (without HIV coinfection) has been reported to occur in 6% cases of liver disease and is found to increase to approximately 20% in patients who are infected with HIV prior to HBV exposure.[3]

HIV superinfection leads to increase in HBV replication but liver inflammation lessens and transaminase values decrease with the histological evidence of a less severe liver disease[3]. Despite this trend towards a milder disease, acute asymptomatic recurrent hepatitis B has been reported, with abrupt onset of symptoms and elevated serum HBV-DNA levels in patients with HBV and HIV coinfection.[3]

A reduced survival rate with a higher rate of hepatic decompensation and chronic viral liver disease among coinfected patients has been reported.[4] Co-infection of HBV and HIV leads to a complex immuno-pathological disease heralding a poor prognosis. In view of these observations routine evaluation of HIV markers should be carried out in all the HBsAg positive individuals for better prognosis and survival of these patients.

References

1Dharmadhikari CA, Kulkarni RD, Kulkarni V, Udgaonkar, Pawar SG. Incidence of hepatitis B surface antigen in liver diseases and voluntary blood donors. J Indian Med Assoc 1990;88(3):73-75.
2Dhanvijay AG, Thakar YS, Chande CA. Hepatitis B infection in HIV infected patients. Indian J Med Microbiol 1999;17 (4):167-169.
3Bodsworth NJ, Cooper DA, Donovan B. The influence of HIV type-1 infection on the development of hepatitis B virus carrier state. J Infect Dis 1991;163:1138-40.
4Ockenga J, Tillman HL, Trautween C, Stool M, Manns MP, Schmidt RE. Hepatitis B and C in HIV infected patients - Prevalence and prognostic value. J Hepatol 1997;27(1):8-24.