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Single (B or C), dual (BC or BD) and triple (BCD) viral hepatitis in HIV-infected patients in Madrid, Spain

Arribas, JRa; González-García, JJa; Lorenzo, Aa; Montero, Db; de Guevara, C Ladrónb; Montes, Ma; Hernández, Sa; Pacheco, Ra; Peña, JMa; Vázquez, JJa

Basic Science

Introduction: There are very limited data about the prevalence of multiple hepatitis virus infections in HIV infected individuals. In HIV uninfected individuals with triple BCD hepatitis, hepatitis D virus (HDV) appears to be the dominant virus. However, in HIV infected patients with triple hepatitis it is not known if HDV replication inhibits hepatitis B virus (HBV) and/or hepatitis C virus (HCV) replication.

Methods: We calculated the prevalence of single (B or C), dual (BC) and triple (BCD) hepatitis in 423 HIV-infected patients with positive HCV serum antibodies and/or positive serum HBsAg. In patients with multiple infections we performed an evaluation of serum markers of HBV, HCV and HDV replication.

Results: The prevalence of multiple hepatitis was 4.7% (95% confidence interval, 2.7–6.7%). Multiple hepatitis occurred only among patients who acquired HIV through injection drug use. The most common multiple hepatitis was triple BCD. Patients with hepatitis BC and past or chronic hepatitis D were significantly more likely to have cirrhosis and a negative serum HBeAg and HCV PCR than patients with single hepatitis B or hepatitis C. Patients with chronic hepatitis D showed uniform suppression of HBV and HCV replication markers.

Conclusions: In our geographic area approximately 5% of HIV infected patients with hepatitis suffer multiple hepatitis virus infection. In patients with triple hepatitis BCD virus infection, HDV appears to be the dominant virus causing inhibition of both HBV and HCV replication.

From the aInternal Medicine Service, Hospital La Paz, Autónoma University School of Medicine, Madrid, Spain

bMicrobiology Service, Hospital La Paz, Autónoma University School of Medicine, Madrid, Spain.

Received 17 March, 2005

Accepted 10 June, 2005

Correspondence to J.R. Arribas, Hospital La Paz. Consulta de Medicina Interna II, Paseo de la Castellana, n° 261, 28046 Madrid, Spain. Tel: +34 91 727 70 99; fax: +34 91 729 00 33; e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.