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Identifying hepatitis B in a patient with coexisting HIV infection in a lab setting

Dual Infection of HIV and Hepatitis B Viruses Pose a Global Public Health Threat

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Global Spread of HIV-HBV Co-infection Poses a Major Public Health Challenge Across the Globe
Global Spread of HIV-HBV Co-infection Poses a Major Public Health Challenge Across the Globe

Identifying hepatitis B in a patient with coexisting HIV infection in a lab setting

Significant Health Concern: Coinfection with HIV and Hepatitis B Virus (HBV)

The simultaneous infection of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) presents a significant global health challenge. This concurrent infection significantly impacts the course of both diseases, exacerbating prognosis and increasing the risk of complications such as liver cirrhosis and hepatocellular carcinoma.

Given the high prevalence of HBV among individuals living with HIV (PLHIV), timely and accurate laboratory diagnosis is essential for determining treatment strategies, monitoring therapy effectiveness, and preventing further transmission.

HIV infection, characterized by progressive immune system dysfunction, can significantly alter the body's response to HBV, necessitating special attention when interpreting laboratory test results. The relationship between HIV and HBV is intricate and multifaceted. Immunosuppression resulting from HIV severely influences the progression of hepatitis B. PLHIV often exhibit higher HBV viral loads, increasing the risk of chronic infection. Moreover, these individuals might experience delayed anti-HBe antibody formation, indicating prolonged viral replication.

Liver diseases associated with HBV, like fibrosis and cirrhosis, progress more rapidly in HIV-infected individuals. Conversely, HBV can also impact HIV infection. While there is typically no direct influence on CD4+ T-lymphocyte levels, chronic hepatitis B can complicate antiretroviral therapy (ART) selection due to potential hepatotoxicity of certain drugs and the risk of drug interactions. Additionally, active HBV replication can contribute to chronic inflammation, which may negatively affect the patient's overall health.

Diagnosis of Hepatitis B is based on the detection of several serological markers that reflect the stage of infection, the level of viral replication, and the presence of an immune response. Key markers include HBsAg (hepatitis B surface antigen), anti-HBs (antibodies to the surface antigen), HBcAg (hepatitis B core antigen), anti-HBc (total antibodies to the core antigen), anti-HBc IgM (immunoglobulin M to the core antigen), HBeAg (hepatitis B "e" antigen), anti-HBe (antibodies to the "e" antigen), and HBV DNA (quantitative determination).

In patients infected with HIV, interpreting serological test results for HBV can be challenging due to their unique immune status. Immunosuppression can lead to lower antibody titers (anti-HBs, anti-HBe), making the diagnosis of past infection or assessing vaccination efficacy challenging.

In rare cases, very low viral load or mutations can result in false-negative HBsAg results. "Occult" hepatitis B (occult HBV infection) is characterized by the presence of HBV DNA in serum or liver tissue with a negative HBsAg result and is particularly significant in HIV patients, as it may reactivate.

Detection of anti-HBc may be the only serological marker suggesting previous virus contact. HBV DNA level determination by PCR plays a crucial role in diagnosing active viral replication, especially in unclear serological results, and is vital for treatment monitoring and transmission risk assessment. HBV genotyping may have prognostic value and impact treatment response.

Patients on long-term treatment may develop drug resistance, requiring appropriate testing.

Given the unique aspects of HBV laboratory diagnosis in HIV patients, clear diagnostic algorithms should be followed. All patients with newly diagnosed HIV infection should be screened for HBsAg, anti-HBs, and anti-HBc. Further actions depend on the combination of these markers. In suspected acute hepatitis B, HBsAg, anti-HBc IgM, and HBV DNA level should be determined.

Regular monitoring of chronic hepatitis B involves determining the level of HBV DNA, HBeAg/anti-HBe, and liver function biochemical markers. In HBsAg-negative patients with positive anti-HBc and risk factors for "occult" hepatitis B, consider testing for HBV DNA.

Interpreting HBV test results in HIV-positive individuals requires a careful analysis of all data in the clinical context and serves as the basis for treatment and monitoring decisions. It is crucial to emphasize the need for an interdisciplinary approach.

Therefore, the laboratory diagnosis of hepatitis B in HIV-infected patients is a complex task that requires in-depth knowledge of the particularities of the interaction between these two viruses and the impact of immunosuppression on serological responses. Strict adherence to testing algorithms, consideration of possible atypical results, and wide use of quantitative HBV DNA determination are key elements of effective diagnosis and monitoring.

A.B. Abenova, a medical laboratory specialist at the diagnostic laboratory of the "Center for HIV Prevention" public health center in Akimat of Astana city, highlighted the importance of following clear diagnostic algorithms, regular monitoring, and an interdisciplinary approach in managing HBV in HIV-infected patients.

  1. Science has unveiled the intricate relationship between Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV), two significant medical conditions.
  2. The concurrent infection of HIV and HBV is a global health concern, exacerbating the prognosis and increasing the risk of complications.
  3. Given the high prevalence of HBV among individuals living with HIV (PLHIV), timely and accurate laboratory diagnosis is essential.
  4. HIV infection can significantly alter the body's response to HBV, necessitating special attention when interpreting laboratory test results.
  5. PLHIV often exhibit higher HBV viral loads, increasing the risk of chronic infection.
  6. These individuals might experience delayed anti-HBe antibody formation, indicating prolonged viral replication.
  7. Liver diseases associated with HBV progress more rapidly in HIV-infected individuals.
  8. Conversely, HBV can also impact HIV infection, complicating antiretroviral therapy (ART) selection.
  9. HIV-infected individuals may experience chronic inflammation due to active HBV replication, negatively affecting overall health.
  10. Diagnosis of Hepatitis B is based on the detection of several serological markers.
  11. Key markers include HBsAg, anti-HBs, HBcAg, anti-HBc, anti-HBc IgM, HBeAg, anti-HBe, and HBV DNA.
  12. Immunosuppression can lead to lower antibody titers in HIV patients, making the diagnosis of past infection or assessing vaccination efficacy challenging.
  13. In rare cases, very low viral load or mutations can result in false-negative HBsAg results.
  14. "Occult" hepatitis B (occult HBV infection) is particularly significant in HIV patients, as it may reactivate.
  15. Detection of anti-HBc may be the only serological marker suggesting previous virus contact.
  16. HBV DNA level determination by PCR plays a crucial role in diagnosing active viral replication and is vital for treatment monitoring and transmission risk assessment.
  17. HBV genotyping may have prognostic value and impact treatment response.
  18. In patients infected with HIV, patients on long-term treatment may develop drug resistance.
  19. Clear diagnostic algorithms should be followed in all patients with newly diagnosed HIV infection.
  20. Further actions depend on the combination of HBsAg, anti-HBs, and anti-HBc markers.
  21. In suspected acute hepatitis B, HBsAg, anti-HBc IgM, and HBV DNA level should be determined.
  22. Regular monitoring of chronic hepatitis B involves determining the level of HBV DNA, HBeAg/anti-HBe, and liver function biochemical markers.
  23. In HBsAg-negative patients with positive anti-HBc and risk factors for "occult" hepatitis B, consider testing for HBV DNA.
  24. Interpreting HBV test results in HIV-positive individuals requires a careful analysis of all data in the clinical context.
  25. Strict adherence to testing algorithms, consideration of possible atypical results, and wide use of quantitative HBV DNA determination are key elements of effective diagnosis and monitoring.
  26. The laboratory diagnosis of hepatitis B in HIV-infected patients is a complex task that requires in-depth knowledge of the particularities of the interaction between these two viruses.
  27. An interdisciplinary approach is crucial in managing HBV in HIV-infected patients.
  28. Effective diagnosis and monitoring help in determining treatment strategies, monitoring therapy effectiveness, and preventing further transmission.

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