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Complications in treating chronic hepatitis B in patients with HIV

Vincent Soriano1, Marina Nuñez, Julie Sheldon

  • 1Department of Infectious Diseases, Hospital Carlos III, Calle Sinesio Delgado 10, 28029 Madrid, Spain. vsoriano@dragonet.es

Expert Opinion on Pharmacotherapy
|December 2, 2005
PubMed

Insights

Managing chronic hepatitis B virus (HBV) with HIV requires careful drug selection. Antiretrovirals like tenofovir and emtricitabine offer dual activity, with nucleotide analogues providing a higher resistance barrier than nucleoside analogues.

Area of Science:

  • Hepatology
  • Virology
  • Infectious Diseases

Background:

  • Chronic hepatitis B virus (HBV) management is complicated by human immunodeficiency virus (HIV) coinfection.
  • Therapeutic strategies must address both viral infections simultaneously.

Purpose of the Study:

  • To review current therapeutic options for chronic HBV in HIV-coinfected individuals.
  • To compare the efficacy and resistance profiles of different antiviral agents.

Main Methods:

  • Review of approved drugs for chronic HBV treatment.
  • Evaluation of antiretrovirals with dual activity against HIV and HBV.
  • Comparison of nucleotide and nucleoside analogue resistance barriers.

Main Results:

  • Four drugs are approved for chronic HBV: IFN-alpha, lamivudine, adefovir, and entecavir.
  • Tenofovir and emtricitabine possess dual antiviral activity, expanding HBV treatment options in coinfected patients.
  • Nucleotide analogues (adefovir, tenofovir) exhibit higher genetic resistance barriers than nucleoside analogues (lamivudine, emtricitabine).
  • Absence of cross-resistance mutations between drug families facilitates salvage and combination therapies.
  • Pegylated interferon-alpha shows promise despite poorer response rates in coinfected individuals.

Conclusions:

  • Treatment of HBV/HIV coinfection necessitates a dual-acting therapeutic approach.
  • Nucleotide analogues offer advantages in resistance management for HBV treatment.
  • Combination and salvage therapies are viable options due to distinct resistance pathways.

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