CHRONIC HEPATITIS-B AND HEPATITIS-C IN HI V-INFECTED PATIENTS

Background and aim: This retrospective study examined the prevalence o f coinfections with hepatitis B virus (HBV) and hepatitis C virus (HCV ) and the frequency of chronic hepatitis in HIV-infected patients with respect to both the different risk groups and the serological results . Patients and methods: All Zurich participants of the Swiss HIV Cohor t Study were evaluated who had available results of hepatitis B and C serology and ALT. Results: Of the total 279 patients, 52% belonged to the intravenous drug user, 34% to the homosexual, and 11% to the heter osexual risk category. Serologically, previously acquired infection wi th HBV alone could be demonstrated in 92 (33%), HCV alone in 9 (3%), a nd both HBV and HCV in 130 (47%) patients. Only 3% of patients with se xually acquired HIV infection had anti-HCV antibodies, whereas co-infe ction with HBV and HCV was present in 87% of intravenous drug users. A mong the 222 patients with previous HBV contact, 25 (11%) had positive HBsAg and 91 (41%) had >>anti-HBc alone<<, both assumed to represent active HBV infection. 66 (24%) of 279 patients had chronic hepatitis w ith ALT elevation lasting greater than or equal to 6 months. Chronic h epatitis was present in 46% of those with active HBV and HCV co-infect ion, in 36% of those with HCV infection alone and in 18% of those with active HBV infection alone (P < 0.001). Of the 66 cases of chronic he patitis, 58 were associated with HCV infection, and only 2 cases had n o serological signs of active HBV or HCV infection. Conclusion: In pat ients with sexually acquired HIV infection, HBV had frequently been co -transmitted. In contrast, almost all of those infected by means of in travenous drug use had a co-infection with both HBV and HCV. The latte r seems to play the strongest role in the development of chronic hepat itis with persistent ALT elevation. A chronic ALT elevation was almost always associated with serologically active HBV or HCV infection.