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HIV/HBV coinfection : double trouble? : retrospective study outlining its negative synergistic effect
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Resumo(s)
A prevalência de infeção pelo vírus da hepatite B (VHB) é de 7,4% nas pessoas que vivem com infeção pelo vírus da imunodeficiência humana (VIH), com percentagens maiores em países em vias de desenvolvimento, nomeadamente na região da África Sub-Sariana de acordo com a Organização Mundial da Saúde (OMS). A coinfeção VIH/VHB está associada a um aumento do risco de morte relacionada com o fígado, comparativamente a doentes monoinfetados pelo VHB. Este risco é reduzido usando terapia anti-retroviral que tem atividade contra ambos os vírus. Existe um número reduzido de registos relacionados com a prevalência e efeitos clínicos desta co-infeção. Consequentemente, o autor decidiu investigar a informação disponível sobre esta t´pico e descrever uma coorte de pacientes com coinfeção VHB/VIH, com seguimento médico no Hospital Professor Doutor Fernando Fonseca (HFF) em Portugal, um contexto com um número particularmente elevado de migrantes provenientes da África Sub-Sariana
O autor compilou informação recente e disponível acerca desta co-infeção. Para além disto, uma coorte de doentes co-infetados do HFF foi descrita, retrospetivamente, analizando vairáveis sociodemográficas, caracterizando ambas as infeções, descrevendo os tratamentos e demonstrando resultados clínicos e baseados em scores de fibrose hepática não invasivos. Adicionalmente, aferiu-se a prevalência de coinfeções por outros vírus hepatotrópicos. Para medicão dos resultados de fibrose, foram usados dois scores internacionalmente reconhecidos, aspartate aminotransferase to platelet ratio index (APRI) e o Fibrosis-4 index (Fib-4).
Os resultados revelaram que regimes terapêuticos baseados em Tenofovir foram eficazes a atingir estabilidade clínica. Além disto, os scores de fibrose mostraram uma diminuição no seu valor ao longo do tratamento. A troca de fármacos entre regimes terapêuticos baseados em Tenofovir Disoproxil fumarato (TDF) para regimes baseados em Tenofovir Aladenamida mostrouser segura em termos de outcomes clínicos.
There is a prevalence of 7.4% of Hepatitis B Virus (HBV) infection in people living with Human Immunodeficiency Virus (HIV), with higher rates in developing countries, namely, sub-Saharan Africa according to the World Health Organization. HIV/HBV coinfection is associated with an increased risk of liver-related mortality, compared with patients with HBV infection alone. This risk is lowered by using antiretroviral therapy that has activity against both viruses. There is underreport of HIV/HBV coinfection prevalence and clinical outcomes. Consequently, the author decided to investigate accessible information on this subject and describe a cohort of patients with HIV/HBV coinfection, under medical follow-up in Hospital Professor Doutor Fernando Fonseca (HFF), Portugal, a setting with a particularly elevated number of migrants from sub-Saharan Africa. The author compiled recent and available information regarding HIV/HBV infection. In addition, cohort of co-infected patients from HFF was described retrospectively analyzing sociodemographic variables, characterizing both infections, describing treatment, clinical and non-invasive fibrosis scores outcomes and assessing the prevalence of additional coinfections by other hepatotropic viruses. To measure fibrosis outcomes, two internationally recognized scores were used, Aspartate aminotransferase to platelet ratio index (APRI) score and Fibrosis-4 index (Fib-4). Results revealed that Tenofovir based therapy was effective in achieving clinical stability. Moreover, fibrosis scores showed a decrease in value, over the course of therapy. Drug switch from Tenofovir Disoproxil Fumarate (TDF)-based therapy to Tenofovir Alafenamide (TAF)-based therapy appeared to be safe in terms of clinical outcomes.
There is a prevalence of 7.4% of Hepatitis B Virus (HBV) infection in people living with Human Immunodeficiency Virus (HIV), with higher rates in developing countries, namely, sub-Saharan Africa according to the World Health Organization. HIV/HBV coinfection is associated with an increased risk of liver-related mortality, compared with patients with HBV infection alone. This risk is lowered by using antiretroviral therapy that has activity against both viruses. There is underreport of HIV/HBV coinfection prevalence and clinical outcomes. Consequently, the author decided to investigate accessible information on this subject and describe a cohort of patients with HIV/HBV coinfection, under medical follow-up in Hospital Professor Doutor Fernando Fonseca (HFF), Portugal, a setting with a particularly elevated number of migrants from sub-Saharan Africa. The author compiled recent and available information regarding HIV/HBV infection. In addition, cohort of co-infected patients from HFF was described retrospectively analyzing sociodemographic variables, characterizing both infections, describing treatment, clinical and non-invasive fibrosis scores outcomes and assessing the prevalence of additional coinfections by other hepatotropic viruses. To measure fibrosis outcomes, two internationally recognized scores were used, Aspartate aminotransferase to platelet ratio index (APRI) score and Fibrosis-4 index (Fib-4). Results revealed that Tenofovir based therapy was effective in achieving clinical stability. Moreover, fibrosis scores showed a decrease in value, over the course of therapy. Drug switch from Tenofovir Disoproxil Fumarate (TDF)-based therapy to Tenofovir Alafenamide (TAF)-based therapy appeared to be safe in terms of clinical outcomes.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Vírus da imunodeficiência humana (VIH) Virus da hepatite B (HBV) Coinfecção Sinergia Tenofovir Doenças transmissíveis