Treatment algorithm for chronic hepatitis B in HIV-infected patients

Area of Science:

• Hepatology
• Infectious Diseases
• Antiviral Therapy

Background:

• Treatment of chronic hepatitis B (CHB) in HIV-infected patients is complex.
• Lack of controlled trials and dual activity of agents on both viruses complicate recommendations.
• Pragmatic approaches using data from HBV mono- and HIV/HBV co-infected studies are necessary.

Purpose of the Study:

• To provide pragmatic recommendations for optimal anti-HBV therapy in HIV-infected patients.
• To review approved CHB drugs and their efficacy/resistance profiles in co-infected individuals.
• To guide drug selection based on patient status (naive, requiring HIV therapy, HBV resistance).

Main Methods:

• Review of approved anti-CHB drugs: interferon alpha (IFN), lamivudine (LAM), entecavir (ETV), adefovir dipivoxil (ADV).
• Analysis of drugs approved for HIV and active against HBV: LAM, tenofovir disoproxil fumarate (TDF), emtricitabine (FTC).
• Evaluation of drug efficacy, resistance profiles, and suitability for different patient subgroups.

Main Results:

• IFN shows decreased response in co-infected patients.
• LAM and FTC are effective but associated with high HBV resistance rates.
• ETV, ADV, and TDF are effective against wild-type and LAM-resistant HBV; ADV and TDF have favorable resistance profiles.

Conclusions:

• For HBV-naive patients not requiring HIV therapy, interferon, ADV, or ETV are preferable.
• Combination therapy with TDF plus FTC or LAM is recommended for patients needing treatment for both viruses.
• TDF should be included in antiretroviral regimens for patients with lamivudine-resistant HBV.