title: Multiple viral infections.
abstract: Individuals at risk of HIV are concomitantly at risk of acquiring parenterally or sexually transmitted viruses. Multiple hepatitis co-infection (HBV+HCV; HBV+HDV; HBV+HDV+HCV) has not been systematically sought after in the large cohorts of HIV-infected patients, but has been reported in 0.4% to more than 50% of patients. HIV-infected patients with multiple hepatitis have a higher rate of liver-related morbidity and mortality than patients with HIV infection alone or with a single hepatitis co-infection. The degree of immunodepression is an important factor in liver disease progression. Since GBV-C virus is transmitted parenterally or by sexual contact, a high prevalence was found in chronic hepatitis C and in HIV-infected patients. Patients with multiple hepatitis have been excluded from randomised therapeutic trials of viral hepatitis in HIV-infected and HIV-negative patients. Thus, the therapeutic approach is based on the results of a small series and empirically oriented toward the prevailing infection. HIV-infected patients should be tested for hepatitis B, C and D systematically and hepatitis B vaccination should be considered for those with HCV co-infection and absence of HBV markers. Studies are needed to assess treatment strategies.
authors.affiliation: Department of Infectious Diseases, Viral Hepatitis Unit, Second University of Naples, Naples 80135, Italy. giovannib.gaeta@unina2.it
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Gaeta
authors.forename: Davide F
authors.initials: DF
authors.lastname: Precone
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cozzi-Lepri
authors.forename: Paola
authors.initials: P
authors.lastname: Cicconi
authors.forename: Antonella
authors.initials: A
authors.lastname: D'Arminio Monforte
mesh_terms: D014943:Global Health; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D003699:Hepatitis D / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence