Epidemiology of viral hepatitis and HIV co-infection

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Worldwide, hepatitis B virus (HBV) accounts for an estimated 370 million chronic infections, hepatitis C virus (HCV) for an estimated 130 million, and HIV for an estimated 40 million. In HIV-infected persons, an estimated 2–4 million have chronic HBV co-infection and 4–5 million have HCV co-infection. HBV, HCV and HIV share common routes of transmission, but they differ in their prevalence by geographic region and the efficiency by which certain types of exposures transmit them. Among HIV-positive persons studied from Western Europe and the USA, chronic HBV infection has been found in 6–14% overall, including 4–6% of heterosexuals, 9–17% of men who have sex with men (MSM), and 7–10% of injection drug users. HCV infection has been found in 25–30% of HIV-positive persons overall; 72–95% of injection drug users, 1–12% of MSM and 9–27% of heterosexuals. The characteristics of HIV infected persons differ according to the co-infecting hepatitis virus, their epidemiologic patterns may change over time, and surveillance systems are needed to monitor their infection patterns in order to ensure that prevention measures are targeted appropriately.

Introduction

Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are among the top 10 leading causes of infectious disease deaths worldwide (1). Globally, chronic infection with each of these viruses alone contributes to substantial morbidity; HBV infection accounts for an estimated 370 million chronic infections, HCV infection for an estimated 130 million, and HIV infection for an estimated 40 million [2], [3], [4]. These viruses share common routes of transmission, but they differ in efficiency by which certain types of exposures transmit them and in their prevalence by geographic region.

Section snippets

HBV infection

The endemicity of HBV infection is influenced primarily by the age at which most infections occur (5). Endemicity of infection is high in those parts of the world where almost all infections occur during the perinatal period or early in childhood (for example, Southeast Asia and sub-Saharan Africa). At least 8% of the population in these areas is chronically infected and 70–90% has serological evidence of previous HBV infection. Risk of HBV infection continues after the first 5 years of life,

HCV infection

The estimated worldwide prevalence of HCV infection is 2.2% (3). Similar to HBV, geographic differences in the endemicity of HCV infection can be described based on regional prevalences; high (prevalence≥3%) moderate (prevalence 2–2.9%), low (prevalence 1.0–1.9%), and very low (prevalence<1.0%) [3], [22]. However, the regions corresponding to these prevalences are different for HCV than for HBV. Highest prevalence of HCV infection has been reported from Northern Africa (particularly Egypt),

Co-infection with HIV

Among the estimated 40 million persons infected with HIV worldwide, an estimated 2–4 million are chronically infected with HBV and an estimated 4–5 million are chronically infected with HCV. Several factors influenced these co-infection estimates, including geographic differences in the prevalence of chronic infection by age, the efficiency of exposures that account for most transmission, and the prevalence of persons at high risk for infection.

For example, in sub-Saharan Africa, heterosexual

Summary

In summary, the characteristics of HIV infected persons differ according to the co-infecting hepatitis virus, and the epidemiology of the three viruses changes over time. In some Western European countries, 30–60% of infected sexual partners recently identified as sources for acute cases of hepatitis B and most HBV and HIV infected female commercial sex workers were from countries with high HBV and HIV prevalences, primarily sub-Saharan Africa. In Northern Europe, most injection drug users

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