Monitoring of HIV and viral hepatitis
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In this article, Colette Smit and Anna Jansen discuss the contribution SHM makes in monitoring hepatitis B (HBV) and hepatitis C virus (HCV) infections. Colette Smit is an epidemiologist at SHM, with a research focus on developing statistical models to understand the role of HBV and HCV co-infection in HIV disease progression and the impact of treatment of co-infections on this progression. Anna Jansen is a data monitor at SHM. She is responsible for managing the implementation of any hepatitis-related dataset changes within SHM’s database. |
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HIV and HBV/HCV co-infection
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are common in HIV patients. Chronic infections with HBV and HCV may result in severe liver disease such as fibrosis, cirrhosis and hepatocellular carcinoma up to 20 to 25 years after infection. Co-infection with HIV however can accelerate this course.
Population
Of the SHM registered HIV-infected patients screened for viral hepatitis, 1372 (8%) patients were infected with HBV, 2004 (12%) were infected with HCV, and 189 patients were infected with HBV and HCV. The number of new HCV infections has risen sharply since 2000; this increase is not seen in the number of new HBV infections1.
Liver disease and morbidity
In patients registered by SHM with HBV co-infection, 69 (5%) of patients were found to have liver disease. Within this group, hepatocellular carcinoma was found in 16 patients. Liver disease was detected in 149 (7%) of HCV co-infected patients, including 10 cases of hepatocellular carcinoma. Of the patients with a HBV co-infection, 178 died and in 15% of cases the cause of death was HBV-related. Of the HCV co-infected patients, 387 died and 15% of the deaths were HCV-related.
Treatment
A number of antiretroviral treatments, such as lamivudine, emtricitabine and tenofovir, are used for the treatment of HIV, but have been found to also suppress HBV. A total of 816 (59%) HIV/HBV co-infected patients were treated with a cART combination that included at least one of these compounds.
Chronic HCV is currently treated with a combination of pegylated interferon and ribavirine. This treatment has been registered with 545 (27%) of HIV/HCV co-infected patients. In contrast to treatment of HBV infection, treatment of HCV infection is not life-long but ranges in duration from 24 up to 72 weeks.
Expanded data collection of HIV and viral hepatitis
SHM collects and monitors data related to the effect of HBV/HCV co-infection on HIV infection as well as the effectiveness of treatment of these co-infections. This contributes to the quality of HIV care and the quality of treatment of hepatitis co-infections. SHM also contributes to research into the treatment of HBV/HCV co-infections.
SHM has made sizeable steps in expanding the data collected on the course and treatment of HBV and HCV in HIV-infected patients. This expansion applies to data related to diagnosis, liver disease, anti-HBV and anti-HCV therapy and its’ effect. Within the database, space has also been created for registration and monitoring of treatment with new compounds. The expansion of the dataset with data on the course and treatment of viral hepatitis was developed by the NVHB/SHM hepatitis working group which was founded in March 2010. Comprehensive HIV/hepatitis data collection will start in all HIV treatment centres in 2012.
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1 Source: SHM Monitoring Report 2011