摘要
The prevalence of human immunodeficiency virus(HIV) and hepatitis B virus(HBV) co-infection is high as they share similar mechanisms of transmission. The development and widespread use of highly sensitive tests for HBV diagnosis has demonstrated that a significant proportion of apparently healthy individuals with evidence of exposure to HBV continue to carry fully functional HBV DNA in their hepatocytes, a situation that predisposes them to the development of progressive liver disease and hepatocellular carcinoma. The presence of co-infections frequently influences the natural evolution of each of the participating infections present by either facilitating their virulence or competing for resources. Furthermore, the drugs used to treat these infections may also contribute to changes in the natural course of these infections, making the analysis of the impact of co-infection more difficult. The majority of studies has examined the impact of HIV on overt chronic hepatitis B, finding that co-infection carries an increased risk of progressive liver disease and the development of hepatocellular carcinoma. Although the effect of HIV on the natural history of occult hepatitis B infection(OBI) has not been fully assessed, all available data suggest a persisting risk of repeated flares of hepatitis and progressive liver disease. We describe studies regarding the diagnosis, prevalence and clinical significance of OBI in HIVpositive patients in this short review. Discrepancies in worldwide prevalence show the urgent need for the standardization of diagnostic criteria, as established by the Taormina statements. Ideally, standardized protocols for testing should be employed to enable the comparison of data from different groups. Additional studies are needed to define the differences in risk for OBI without HIV and in HIV-HBV co-infected patients with or without overt disease.
The prevalence of human immunodeficiency virus（HIV） and hepatitis B virus （HBV） co-infection is highas they share similar mechanisms of transmission. Thedevelopment and widespread use of highly sensitivetests for HBV diagnosis has demonstrated that asignificant proportion of apparently healthy individualswith evidence of exposure to HBV continue to carryfully functional HBV DNA in their hepatocytes, asituation that predisposes them to the development ofprogressive liver disease and hepatocellular carcinoma.The presence of co-infections frequently influencesthe natural evolution of each of the participatinginfections present by either facilitating their virulence orcompeting for resources. Furthermore, the drugs usedto treat these infections may also contribute to changesin the natural course of these infections, making theanalysis of the impact of co-infection more difficult. Themajority of studies has examined the impact of HIVon overt chronic hepatitis B, finding that co-infectioncarries an increased risk of progressive liver diseaseand the development of hepatocellular carcinoma.Although the effect of HIV on the natural history ofoccult hepatitis B infection （OBI） has not been fullyassessed, all available data suggest a persisting riskof repeated flares of hepatitis and progressive liverdisease. We describe studies regarding the diagnosis,prevalence and clinical significance of OBI in HIVpositivepatients in this short review. Discrepancies inworldwide prevalence show the urgent need for thestandardization of diagnostic criteria, as establishedby the Taormina statements. Ideally, standardizedprotocols for testing should be employed to enable thecomparison of data from different groups. Additionalstudies are needed to define the differences in risk forOBI without HIV and in HIV-HBV co-infected patientswith or without overt disease.
基金
Supported by Consejo Nacional de Ciencia y Tecnologia,Mexico(CONACYT 2008-C01-86717
to RL)
