With the current trends in integrated management of childhood diseases in developing countries, it is important to resolve the controversies of coinfections between helminths and malaria, and properly evaluate the epidemiology of diarrhegenic parasites with molecular study, which sometimes cause overlapping infections. Again, the major challenge facing the global success of mass deworming initiative aimed at controlling helminths is lack of sustainability due to limited donor funds. We therefore decided to evaluate the effectiveness of a school based deworming program using only the school teachers without spending money on training and logistics. Demographic information, height and weight were measured and stool samples were collected from pupils in a semi-rural area of Nigeria during the initial visit by the study team. Malaria cases were recorded over a 3 month malaria transmission period prior to stool sampling. Four hundred and seventy six (33%) of the study population was infected with one Soil transmitted helminth (STH) or the other, especially with Askaris lumbricoides (26.0%) and Hookworm (8.4%). We found a negative association between malaria and STH in this community. Helminth infection rate of 18.3% was observed in children with malaria compared to 34.4% in controls. We also found a high carriage rate of Giardia (37.2%), low Cryptosporidium (1%) and no E. histolytica infection contrary to previous studies that were based on traditional diagnostic techniques. There was 7.9% reduction in the number children with low weight-for-age in the helminth infected children at 6 months after mass deworming, the number of uninfected children with low weight-for-age also reduced by 3.2%. There was also a reduction in the number of children with more than 25% absenteeism among both helminth infected (13.9%) as well as uninfected (7.2%). The association between malaria and STH in our study calls for the need for integrated approach to health problem in Africa instead of the common vertical campaigns. Results from our molecular study also shows the need to strengthen collaborations between researchers from developed and developing countries to be able to map out the true epidemiology of these parasites and hopefully produce novel, inexpensive diagnostics that circumvent the need for advance technological infrastructure

No description available.

Au sein des populations naturelles d'êtres vivants circulent une diversité de parasites, qu'il s'agisse de plusieurs espèces, souches ou plus généralement types. Si certains modèles d'épidémiologie évolutive intègrent déjà le polymorphisme des parasites, rares sont ceux pour lesquels la dynamique épidémiologique dépend de la croissance intra-hôte et des interactions que les parasites entretiennent lorsqu’ils infectent le même hôte. Les complexité combinatoire et dynamique explique pourquoi il n'y a pour l'heure pas de prédiction générale de l'évolution de la virulence dans de tels contextes d'infections multiples. À la recherche d'une tendance générale d'évolution de la virulence, nous modélisons chaque niveau de dynamique sur lequel l'évolution des parasites repose. En particulier, nous étudions explicitement les interactions et l'issue de la compétition au sein des hôtes, les dynamiques épidémiologique et enfin adaptative. Sur l'exemple des infections chroniques causées par des micro-parasites transmis horizontalement, nous employons les approches propres aux systèmes dynamiques et aux probabilités pour emboîter cette suite de dynamiques afin d'en explorer les conséquences évolutives. Nous définissions notamment le concept de patron d'infection, à savoir l'ensemble des issues intra-hôte associées à chaque configuration d'inoculation et décrivons cinq patrons jusqu'ici non décrits, lesquels échappent à la dichotomie classique entre super- et coinfection. Cette typologie nous permet par la suite d'envisager l'évolution de la virulence dans un cadre général. Nous observons en particulier une inéluctable mais bornée croissance évolutive de la virulence. / Natural populations of living beings are exposed to a diversity of parasites, be they several species, strains or more generally types. While some evolutionary epidemiology models already incorporate parasite polymorphism, few make the connection between between-host dynamics and within-host parasite growth. As parasite polymorphism can even occur within the same host, distinct parasite types can interact in various ways and thus interfere with their transmission and therefore their evolution. The combinatorial and dynamical complexity explains why we still lack general predictions regarding the evolution of virulence in such multiple infection contexts. Seeking for a general trend in virulence evolution, we model each dynamical level on which parasite evolution relies. In particular, we explicitly investigate the within-host interactions and competition outcomes, the epidemiological and adaptive dynamics. Focusing on chronic infections caused by horizontally-transmitted microparasites, we apply both dynamical systems and probabilistic approaches to this nested sequence of dynamics to explore the evolutionary outcomes. We notably define the concept of infection pattern, that is the set of within-host outcomes of all inoculation challenges and identify five yet undescribed patterns that escape from the classical super/coinfection dichotomy. This typology then allows us to address virulence evolution under a general framework. We in particular observe an unavoidable but bounded evolutionary increase in virulence.

Objectifs : Les objectifs principaux de cette thèse sont les suivants : 1) analyse de l’évolution du profil épidémiologique des patients coinfectés VIH-VHC initiant le traitement de l’hépatite C; 2) l’évaluation de l’impact des comportements de santé et des styles de vie sur l’évolution clinique de la maladie Résultats : J’ai pu mettre en évidence que le profil des patients coinfectés VIH-VHC initiant un traitement de l’hépatite C a changé en France avec l’évolution des traitements.Mes travaux ont permis de montrer que, chez les patients coinfectés VIH-VHC, une consommation élevée de café (3 tasses par jour et plus) diminue le risque de fibrose hépatique avancée. Cet effet bénéfique du café est également observé chez les patients coinfectés VIH-VHC avec une consommation élevée d’alcool. De plus, mes travaux ont mis en évidence une relation dose-dépendante entre la fréquence de consommation de cacao et la réduction du risque de fibrose hépatique avancée chez les patients coinfectés VIH-VHC. Par ailleurs, mes analyses n’ont pas mis en évidence un effet significatif de la consommation de café sur le risque de fibrose hépatique avancée chez les femmes coinfectées VIH-VHC. Enfin l’un des résultats marquant de la relation entre VHC et risque d’obésité qui est connue est que la guérison augmente davantage ce risque sur le long terme. Conclusion : Des interventions pour modifier certains styles de vie et comportements ont le potentiel de diminuer le risque de survenue ou d’aggravation de comorbidités, en particulier après la guérison VHC, un événement désormais atteignable pour tous les patients coinfectés. / Objectives: The main objectives of this thesis are: 1) analysis of the evolution of the epidemiological profile of co-infected HIV-HCV patients initiating the treatment of hepatitis C; 2) assessment of the impact of health behaviors and lifestyles on the clinical course of the diseaseResults: I was able to highlight that the profile of co-infected HIV-HCV patients initiating treatment for hepatitis C has changed in France with the evolution of treatments.My work has shown that, in HIV-HCV coinfected patients, high coffee consumption (3 cups per day or more) decreases the risk of advanced liver fibrosis. This beneficial effect of coffee is also observed in co-infected HIV-HCV patients with high alcohol consumption. In addition, my work has shown a dose-dependent relationship between the frequency of cocoa consumption and the reduced risk of advanced liver fibrosis in coinfected HIV-HCV patients. Furthermore, my analyzes did not reveal a significant effect of coffee consumption on the risk of advanced liver fibrosis in coinfected HIV-HCV women. Finally, one of the striking results of the relationship between HCV and known risk of obesity is that healing increases this risk in the long term.Conclusion: Interventions to modify certain lifestyles and behaviors have the potential to reduce the risk of developing or worsening comorbidities, particularly after HCV healing, an event now achievable for all co-infected patients.

O objetivo deste estudo foi avaliar a distribuição genotípica e mutações no genoma do vírus da hepatite B (VHB) em um grupo de pacientes co-infectados pelo VHB e vírus da imunodeficiência humana (HIV). Foram incluídos pacientes AgHBs +/HIV+ , atendidos em um ambulatório de referência para pacientes infectados pelo HIV, na cidade de São Paulo. Para a detecção dos marcadores sorológicos para infecção pelo VHB utilizou-se técnica de ELISA através de kits comerciais. A detecção do DNA-VHB foi realizada através de nested-PCR e sua quantificação foi realizada por COBAS AMPLICOR. De acordo com a literatura, a infecção pelo VHB no Brasil varia de 0,4 a 8,5%. Os genótipos de VHB, as mutações na região do core, BCP, pré-core e na região da polimerase foram determinados por seqüenciamento. Cinqüenta e nove pacientes foram incluídos neste estudo e cinqüenta e seis pacientes relatavam uso prévio de lamivudina ou tenofovir. A presença do DNA-VHB foi detectada em 22 pacientes AgHBs positivos. A identificação dos genótipos foi realizada em 16 pacientes e a distribuição dos genótipos do VHB foi: A (12-75%); G (2-13%), D (1-6%) e F (1-6%). Em 10 dos pacientes com viremia presente para DNA-VHB, foram observadas mutações na região da polimerase (rtL180M + rtM204V, rtV173L + rtL180M + rtM204V) e no gene do envelope (sI195M, sW196L, sI195M/sE164D). Mutações na região do BCP (A1762T, G1764A) e do pré-core (G1896A) foram identificados em quatro pacientes. Em conclusão, entre os pacientes analisados observou-se uma alta prevalência de mutações associadas a resistência à lamivudina e associadas a resistência a anti-HBs. O genótipo G, raramente descrito em nosso meio, foi também observado nesse grupo de pacientes. / The objective of this study was to evaluate the genotype distribution and genomic mutations of hepatitis B virus (HBV) among a group of HIVHBV co-infected patients from an AIDS outpatient clinic in São Paulo. HBV serological markers were detected by commercially available enzyme immunoassay kits. HBV DNA was detected by using an in-house nested PCR and quantified by COBAS AMPLICOR. HBV genotypes, basal core promoter (BCP) / pre-core / core region and surface / polymerase genes mutations were determined by sequencing. Among the 59 patients included in this study, 56 reported previous use of lamivudine or tenofovir. According to the literature HBV infection in Brazil varies from 0,4 to 8,5%. HBV DNA was detected in 16/22 patients and the genotypes distribution was A (n=12, 75%); G (n=2, 13%); D (n=1, 6%), and F (n=1, 6%). In 10 patients with viremia, lamivudine-resistance mutations in the polymerase gene (rtL180M + rtM204V, rtV173L + rtL180M + rtM204V) were found, accompanied by changes in the envelope gene (sI195M, sW196L, and sI195M/sE164D). Mutations in the BCP and pre-core regions were identified in 4 patients. In conclusion, genotype G, rarely seen in Brazil, was observed in this group of patients. A high prevalence of mutations associated with lamivudine-resistance accompanied by mutations associated with anti-HBs resistance was also found among these patients.

Made available in DSpace on 2016-08-10T10:54:17Z (GMT). No. of bitstreams: 1 PAMELLA FERNANDA MOREIRA.pdf: 1704209 bytes, checksum: 4c9cab3f1c1bf509ca7c228099ec3fa6 (MD5) Previous issue date: 2014-03-12 / This study investigated the prevalence of HBV infection and coinfection with HIV, and risk behaviors associated with male inmates and female of Goiás, Brazil. The sample was composed of men and women of the Prison Complex Aparecida de Goiânia, which provided their risk behaviors and blood to check for the presence of HBsAg marker, and when for these reactants were tested for the presence of anti HIV. In 1173 deprived of liberty the prevalence of HBV was 6.9 % (5.6-8.5), and 6.3% in females and 7% in the male group. The HBV/HIV coinfection was found in two inmates ( 2.5 % ) . The prevalence of HBV infection was higher than that found in several studies in national and international prisons. There were no statistical differences between the sexes for the use of drugs smoked, sniffed and or injected, tattooing and sexual orientation. However, drug users smoked or snuffed have 1.8 times higher risk of having hepatitis B compared with non-use and injecting drug use was not significant for HBV infection. And deprived of liberty with history of previous incarcerations have 1.9 times higher risk of having hepatitis B compared with those with no history of previous incarcerations. / Esta pesquisa investigou a prevalência da infecção pelo HBV e da coinfecção pelo HIV, assim como os comportamentos de riscos associados em detentos do sexo masculino e feminino de Goiás, Brasil. A amostra foi composta por homens e mulheres privados de liberdade do Complexo Prisional de Aparecida de Goiânia, que forneceram dados sobre seus comportamentos de risco e sangue para a verificação da presença do marcador HBsAg, e quando reagentes para este, foram submetidos à pesquisa de anti-HIV. Em 1173 indivíduos privados de liberdade a prevalência do HBV foi de 6,9% (5,6-8,5), sendo de 6,3% no grupo feminino e de 7% no grupo masculino. A coinfecção HBV/HIV foi encontrada em dois detentos (2,5%). A prevalência da infecção pelo HBV foi superior à encontrada em diversos estudos realizados em presídios nacionais e internacionais. Não houve diferenças estatísticas entre os sexos para o uso de drogas fumadas, cheiradas e/ou injetáveis, tatuagens e opção sexual. Contudo, usuários de drogas fumadas ou cheiradas possuem risco 1,8 vezes maior de ter hepatite B se comparados com os que não usam e o uso de drogas injetáveis não foi significativo para a infecção pelo HBV. E indivíduos privados de liberdade com histórico de encarceramentos anteriores possuem risco 1,9 vezes maior de ter hepatite B se comparados com os sem histórico de encarceramentos anteriores.

Introdução: A evolução dos marcadores sorológicos da hepatite B em pacientes com hepatite B crônica coinfectados com o vírus da imunodeficiência humana (HIV) tem sido pouco documentada. Objetivos: O objetivo deste estudo foi descrever a evolução dos marcadores sorológicos AgHBe e AgHBs, com ênfase na avaliação da frequência de perda definitiva ou transitória desses marcadores, neste grupo de pacientes. Buscamos, também, comparar as variáveis clínicas e demográficas desses pacientes segundo a evolução desses marcadores sorológicos. Pacientes e métodos: A população de estudo foi composta por pacientes atendidos em um ambulatório de referência para atendimento a pacientes infectados pelo HIV em São Paulo, Brasil. Todos os pacientes selecionados eram portadores de HIV e de hepatite B crônica. Foram incluídos nesse estudo pacientes AgHBs positivos, com confirmação da presença desse marcador em, no mínimo, duas sorologias consecutivas, com intervalo mínimo de seis meses entre elas. Variáveis clínicas foram coletadas: idade, sexo, fator de exposição ao HIV/VHB, contagem de células T CD4+, carga viral do HIV, níveis de alaninoaminotransferase (ALT), uso de terapia antirretroviral, incluindo lamivudina, tenofovir ou outras drogas com ação anti-VHB. Resultados: Entre 2.242 pacientes HIV positivos encontrados, foram identificados 105 (4,68%) pacientes com hepatite B crônica. O tempo de seguimento variou de 06 meses a 20,5 anos e o número de coletas variou de 2 a 18 por paciente no período. A maioria dos pacientes era do sexo masculino (97%) e 43,9% (46/105) tinha história de uma ou mais infecções oportunistas. Todos os pacientes tiveram terapia antirretroviral iniciada durante o seguimento. Entre os pacientes com hepatite B crônica, 58% (61/105) eram AgHBe positivos na primeira avaliação. Entre eles, 15% (16/105) apresentaram clareamento de AgHBs e 50% (8/16) dos que clarearam AgHBs apresentaram posterior reativação desse marcador durante a evolução clínica. Dentre os pacientes AgHBe positivos na primeira sorologia, 57% (35/61) apresentaram clareamento desse marcador, sendo que 28,5% (10/35) dos que clarearam AgHBe voltaram a apresentar este marcador durante a evolução clínica. Conclusão: Observamos uma significativa taxa de clareamento e posterior reativação dos marcadores AgHBs e AgHBe no grupo de pacientes avaliados. Estes resultados sugerem que o monitoramento frequente desses marcadores sorológicos deveria ser recomendado / Introduction: Evolution of hepatitis B serological markers among HIV co-infected patients has rarely been documented. Objectives: The aim of this study was to describe the evolution of HBsAg and HBeAg serological markers, with emphasis on the frequency of transient or permanent loss of these markers, among this group of patients. It was also our objective to compare patients\' demographic and clinical variables according to the evolution of these serological markers. Patients and methods: The enrolled patients were selected from those registered at a HIV-Outpatient Clinic in Sao Paulo, Brazil. All included patients were diagnosed with HIV infection and chronic hepatitis B. HBsAg patients who underwent at least two repeated HBV serological testing during clinical follow up , with tests taken at least six months apart, were included in the analysis. Clinical information was collected: age, sex, patient history regarding HIV/HBV transmission, CD4 T+ cell count, HIV viral load, alanine amino transferase (ALT) level, and use of antiretroviral drugs including lamivudine, tenofovir or other anti-HBV drugs. Results: Among 2,242 HIV-positive patients 105 (4.68%) patients were identified with chronic hepatitis B. Follow-up time for these patients varied from 06 months to 20.5 years and the number of serological testing for each patient varied from 2 to 18 along this period. Most patients were male (97%) and 43.9% (46/105) had a history of one or more opportunistic infections. All patients had initiated antiretroviral medication during follow-up. Among patients with chronic hepatitis B, 58% (61/105) were HBeAg reagent at the first assessment. Also, fifteen percent of them (16/105) underwent HBsAg clearance and 50% (8/16) of those who initially lost HBsAg underwent HBsAg reactivation during clinical follow up. Among HBeAg positive patients in the first serology, 57% (35/61) lost this marker during clinical follow up, whereas 28.5% (10/35) of those who initially cleared this serological marker underwent HBeAg reactivation. Conclusion: A significant rate of changes of HBsAg and HBeAg was observed, during clinical follow up among this group of patients. These results suggest that periodic monitoring of HBV serological markers should be recommended

This thesis aimed to understand the mechanisms underlying within-host interactions among coinfecting parasites in wild rodents, how they are affected by the host immune response, and how they contribute to shape disease dynamics in nature. Coinfection is ubiquitous in human, domestic and wild animal populations, and can consist of both microparasites (viruses, bacteria and protozoa) and macroparasites (parasitic helminths). Moreover, coinfecting parasites can interact with each other in a number of ways (positive or negative, direct or indirect), which affects disease severity and progression, parasite transmission, the response of target and non-target parasites to treatment and, ultimately, the epidemiology of each coinfecting parasite species. While previous work on laboratory animals has generated detailed knowledge of the cellular components of the host immune response involved during coinfection, we still mostly lack a conceptual understanding of the role of the host immune response in mediating within-host interactions in nature. I used a known within-host interaction between two important intestinal parasites (the nematode Heligmosomoides polygyrus and the protozoan Eimeria hungaryensis) of wild wood mice (Apodemus sylvaticus) to study the underlying causes and consequences of this interaction for both parasite dynamics and host health. I first investigated if specific and total antibody levels can explain natural burdens and infection of H. polygyrus and Eimeria spp. in the context of other parasites and variation in host demography in a cross-sectional field study. I found that H. polygyrus-specific IgG1 and total faecal IgA were the strongest predictors of both H. polygyrus infection and burden and Eimeria spp. infection. Further, Eimeria spp. infection was associated with lower antibody levels, suggesting an interaction between Eimeria spp. and anti-helminth immunity. Next, I tested the causative relationship between antibody levels and parasite infection. Over the course of a longitudinal anthelmintic treatment study in the field, I measured infection and burden of both target and non-target parasites, as wells as specific and general antibody levels. I found that treatment successfully reduced H. polygyrus burden, wild led to a change in both antibody levels and E. hungaryensis dynamics. Further, H. polygyrus-specific IgG1 levels were predicted by pre-treatment H. polygyrus burden, suggesting that helminth infection induces antibody production, rather than vice versa. Following from this, I explored if treatment of single or multiple parasite groups (helminths, coccidia or both) had an effect on host survival. I used data from a longitudinal field study spanning an entire season of A. sylvaticus (April-December), where animals were given either Ivermectin (anthelmintic), Vecoxan (anti-coccidial), a mix of both drugs or water every fortnight. Ivermectin treatment led to a consistent reduction in H. polygyrus prevalence and burden, as well as a steady increase in E. hungaryensis prevalence, whereas Vecoxan treatment failed to show any effect on either target or non-target parasites. Interestingly, anthelmintic treatment led to a reduction in survival at intermediate H. polygyrus burdens, suggesting that anti-parasite treatments might not always be beneficial for the host. By bringing this wild coinfection system into the lab, I examined if the interaction between H. polygyrus and E. hungaryensis could be re-created under controlled laboratory condition, and if the lack of environmental variation had an effect on parasite and/or antibody dynamics. I found that coinfection led to a delay in H. polygyrus expulsion, and decreased E. hungaryensis shedding during chronic helminth infection. However, coinfection did not affect antibody dynamics. This not only demonstrated that the interaction between the two parasites was reciprocal, but also showed that coinfection can significantly affect parasite transmission dynamics. In an ongoing bioinformatic analysis, I investigated the level of genetic diversity in wild Eimeria spp. populations in order to uncover the mechanism underlying a common lack of protective immunity towards Eimeria spp. infections in wild and domestic animal populations. I found that there were multiple genetically distinct strains circulating within all populations tested, but homologous re-infection was not less likely than heterologous reinfection. This suggests that the lack of protective immunity in wild Eimeria spp. Populations cannot solely be explained by high levels of genetic diversity. This thesis provides several important insights into the mechanisms underlying parasite within-host interactions. Importantly, it highlights that, whilst host immunity plays a crucial role in determining the outcome of coinfection, other factors such as host demography have to be taken into account in order to understand the interplay between immunity and coinfection. I further show that anti-parasite treatments in the wild can be successful, but the benefits of such treatments can be context dependent. More broadly, my findings can have important implications for the planning and evaluation of treatment programs targeted at both single and coinfected animals and humans in their natural environment.

Foram analisadas 197.032 doações no período de janeiro de 1998 a junho de 2008, realizadas no Banco de Sangue do Hospital de Clínicas de Porto Alegre. Os doadores de sangue foram triados por um teste de enzimaimunoensaio (EIE) de terceira geração para HTLV I/II. Também foram realizados testes para hepatites B e C, HIV 1/2, sífilis e doença de Chagas. Os dados das fichas cadastrais foram revisados após o diagnóstico do doador. Como teste confirmatório, foi utilizado o Western Blot (WB). Foram excluídos os doadores considerados negativos após a confirmação dos testes iniciais. Ao todo, 204 doadores foram reagentes para HTLV I ou II. A prevalência de HTLV I/II foi de 0,1%, sendo 0,08% do tipo I e 0,02% do tipo II. A média de idade foi de 38 anos; 73,5% dos doadores eram brancos e 53,9% do sexo feminino. Cerca de 65% deles completaram o ensino fundamental e apenas 1% o ensino superior; 59,3% eram procedentes de Porto Alegre. A frequência de casados e solteiros foi de 40,2% e 42,4%, respectivamente, sendo os demais separados, divorciados ou viúvos. Os soropositivos para HTLV apresentaram ainda 30,4% de coinfecção com os outros marcadores testados. AntiHCV e anti-HBc foram os marcadores com maior prevalência (19,1% e 18,6%, respectivamente), seguidos por VDRL (2,94%), anti-HIV 1/2 (2,45%) e doença de Chagas (1,96%). / A total of 197,032 donors from the Blood Bank of Hospital de Clínicas de Porto Alegre, in southern Brazil, were assessed from January 1998 to June 2008. Blood donors were screened for HTLV I/II using a third-generation enzyme immunoassay (EIA). Tests for hepatites B and C, HIV 1 and 2, syphilis and Chagas disease were also performed. The information on blood donor forms was reviewed after the diagnosis. The Western Blot (WB) was used as confirmatory test. Seronegative donors were excluded from the study after initial test results were confirmed. Two hundred and four donors were positive for HTLV I or II. The prevalence of HTLV I/II was 0.1% (0.08% for HTLV I and 0.02% for HTLV II). The mean age was 38 years, 73.5% were whites and there was a female predominance (53.9%). Approximately 65% of seropositive individuals had attended elementary school, only 1% had college education, and 59.3% came from Porto Alegre. The frequency of married and single individuals was similar (40.2 and 42.4%, respectively), whereas the remaining donors were separated, divorced or widowed. This population also showed 30.4% of coinfection, according to the other tested markers. Anti-HCV and anti-HBc were the most prevalent markers (19.1 and 18.6%, respectively), followed by VDRL (2.94%), anti-HIV 1/2 (2.45%), Chagas disease (1.96%).

Introdução: A evolução dos marcadores sorológicos da hepatite B em pacientes com hepatite B crônica coinfectados com o vírus da imunodeficiência humana (HIV) tem sido pouco documentada. Objetivos: O objetivo deste estudo foi descrever a evolução dos marcadores sorológicos AgHBe e AgHBs, com ênfase na avaliação da frequência de perda definitiva ou transitória desses marcadores, neste grupo de pacientes. Buscamos, também, comparar as variáveis clínicas e demográficas desses pacientes segundo a evolução desses marcadores sorológicos. Pacientes e métodos: A população de estudo foi composta por pacientes atendidos em um ambulatório de referência para atendimento a pacientes infectados pelo HIV em São Paulo, Brasil. Todos os pacientes selecionados eram portadores de HIV e de hepatite B crônica. Foram incluídos nesse estudo pacientes AgHBs positivos, com confirmação da presença desse marcador em, no mínimo, duas sorologias consecutivas, com intervalo mínimo de seis meses entre elas. Variáveis clínicas foram coletadas: idade, sexo, fator de exposição ao HIV/VHB, contagem de células T CD4+, carga viral do HIV, níveis de alaninoaminotransferase (ALT), uso de terapia antirretroviral, incluindo lamivudina, tenofovir ou outras drogas com ação anti-VHB. Resultados: Entre 2.242 pacientes HIV positivos encontrados, foram identificados 105 (4,68%) pacientes com hepatite B crônica. O tempo de seguimento variou de 06 meses a 20,5 anos e o número de coletas variou de 2 a 18 por paciente no período. A maioria dos pacientes era do sexo masculino (97%) e 43,9% (46/105) tinha história de uma ou mais infecções oportunistas. Todos os pacientes tiveram terapia antirretroviral iniciada durante o seguimento. Entre os pacientes com hepatite B crônica, 58% (61/105) eram AgHBe positivos na primeira avaliação. Entre eles, 15% (16/105) apresentaram clareamento de AgHBs e 50% (8/16) dos que clarearam AgHBs apresentaram posterior reativação desse marcador durante a evolução clínica. Dentre os pacientes AgHBe positivos na primeira sorologia, 57% (35/61) apresentaram clareamento desse marcador, sendo que 28,5% (10/35) dos que clarearam AgHBe voltaram a apresentar este marcador durante a evolução clínica. Conclusão: Observamos uma significativa taxa de clareamento e posterior reativação dos marcadores AgHBs e AgHBe no grupo de pacientes avaliados. Estes resultados sugerem que o monitoramento frequente desses marcadores sorológicos deveria ser recomendado / Introduction: Evolution of hepatitis B serological markers among HIV co-infected patients has rarely been documented. Objectives: The aim of this study was to describe the evolution of HBsAg and HBeAg serological markers, with emphasis on the frequency of transient or permanent loss of these markers, among this group of patients. It was also our objective to compare patients\' demographic and clinical variables according to the evolution of these serological markers. Patients and methods: The enrolled patients were selected from those registered at a HIV-Outpatient Clinic in Sao Paulo, Brazil. All included patients were diagnosed with HIV infection and chronic hepatitis B. HBsAg patients who underwent at least two repeated HBV serological testing during clinical follow up , with tests taken at least six months apart, were included in the analysis. Clinical information was collected: age, sex, patient history regarding HIV/HBV transmission, CD4 T+ cell count, HIV viral load, alanine amino transferase (ALT) level, and use of antiretroviral drugs including lamivudine, tenofovir or other anti-HBV drugs. Results: Among 2,242 HIV-positive patients 105 (4.68%) patients were identified with chronic hepatitis B. Follow-up time for these patients varied from 06 months to 20.5 years and the number of serological testing for each patient varied from 2 to 18 along this period. Most patients were male (97%) and 43.9% (46/105) had a history of one or more opportunistic infections. All patients had initiated antiretroviral medication during follow-up. Among patients with chronic hepatitis B, 58% (61/105) were HBeAg reagent at the first assessment. Also, fifteen percent of them (16/105) underwent HBsAg clearance and 50% (8/16) of those who initially lost HBsAg underwent HBsAg reactivation during clinical follow up. Among HBeAg positive patients in the first serology, 57% (35/61) lost this marker during clinical follow up, whereas 28.5% (10/35) of those who initially cleared this serological marker underwent HBeAg reactivation. Conclusion: A significant rate of changes of HBsAg and HBeAg was observed, during clinical follow up among this group of patients. These results suggest that periodic monitoring of HBV serological markers should be recommended