About 10 percent of the 33 million people infected with HIV worldwide also have hepatitis B (HBV), a virus which leads to chronic liver disease and possible liver cancer.
When the two chronic viruses are combined, each one is deadlier than it is alone.
"Ask your doctor how to protect yourself against HBV."
Writing in the New England Journal of Medicine, a team of public health experts outlined the threat that HIV and HBV “coinfection” pose to global health. They warned that not enough is being done to address the challenge, especially when it comes to preventing HBV transmission from mother to child.
Coinfection describes simultaneous infection by two viruses, which can occupy the same cell. With the combination of HIV and HBV, the outcomes are worse for both.
The viruses have many similarities: Both are lifelong, chronic illnesses that can lead to death, and neither has a cure. They can both develop resistance to antiviral drugs, which makes them difficult to treat.
What's different about HBV is that it can be very common in young children, as it can be transmitted through close household contact or in the months preceding and following birth.
Children are more susceptible to developing chronic hepatitis B – at a risk of 90 percent, as opposed to 5 percent among adults whose immune systems have not been compromised.
In Africa and Asia, where both diseases are prevalent, coinfection can be as high as 25 percent.
In regions where HIV and HBV are less common, such as North America, Europe and Australia, coinfection isn't as much of a risk for young children. It's more often the case that people end up with both viruses from injected drug use or sexual transmission.
Half of injected drug users with HIV also have HBV.
The New England Journal of Medicine article focused on the need to strengthen child and maternal health programs against HBV. In Africa and Asia, the regions with high risk, vaccination that protects infants from infection is underutilized and in some cases, unavailable.
Pregnancy with HBV and HIV is also an issue in developed countries.
“In the United States, the number of HBV-infected pregnant women is probably underestimated, with current methods relying on the expectation that certain ethnic groups are at high risk. In Europe, there is no consistent policy of testing women for HBV infection during pregnancy; some countries rely on assessment of “risk factors” alone.”
“Evaluating the HBV viral load in HIV-infected pregnant women should be an essential step of prenatal evaluation, so that the mother's health can be managed appropriately,” they wrote.
The article was published in June 2012.