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Treatment algorithm for chronic hepatitis B in HIV-infected patients

Yves Benhamou1

  • 1Hôpital Pitié-Salpêtrière, Service d'Hépato-Gastroentérologie, 27 boulevard de l'Hopital, 75013 Paris, France. ybenhamou@teaser.fr

Journal of Hepatology
|December 15, 2005
PubMed

Insights

Treating chronic hepatitis B (CHB) in HIV patients requires careful drug selection due to viral interactions. Tenofovir disoproxil fumarate (TDF) is recommended for patients with lamivudine-resistant hepatitis B virus (HBV).

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.

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