HIV This Week

Modi AA, Feld JJ. Viral hepatitis and HIV in Africa. AIDS Rev. 2007;9(1):25-39.

With increasing access to antiretroviral therapy across sub-Saharan Africa, progress is finally being made in combating the devastating HIV epidemic. As HIV-infected individuals live longer, the effects of co-infection with chronic hepatitis B and C will likely become an increasingly relevant issue. Indeed, HIV adversely affects the natural history of hepatitis B and hepatitis C, both of which are endemic across the African continent. Issues ranging from appropriate diagnostic testing to prevention and treatment are affected by HIV coinfection, particularly in resource-limited settings. In addition, some of the more complex problems such as occult infection, immune reconstitution, and antiretroviral hepatotoxicity are becoming increasingly important considerations. In this review, Modi and Feld present the available data on co-infection in Africa with a major emphasis on prevalence, routes of transmission, prevention, and treatment strategies.

Editors´note: This review reveals surprising information: 70-75% of people across Africa are protected from sexual acquisition of hepatitis B because they were infected during labour and delivery or in early life but 50 million people are chronic carriers. Africa has the highest prevalence of hepatitis C with 5.3% of the population infected. A history of exposure to medical injections or dental therapy is a significant risk factor. Both HIV/hepatitis B co-infection and HIV/hepatitis C co-infection are not uncommon and have implications for prevention and clinical management, particularly as people are living longer with the introduction of antiretroviral treatment.