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Published on: September 25, 2019
Current treatment of HIV/hepatitis B virus coinfection
David M Iser1, Joseph J Sasadeusz
1Department of Gastroenterology, St. Vincent's Hospital, and Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia. david.iser@svhm.org.au
Insights
Managing coinfection with HIV and hepatitis B virus (HBV) requires careful consideration of dual-acting agents. Effective treatment focuses on sustained HBV DNA suppression, often lifelong, and incorporates anti-HBV therapies into HIV regimens.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Coinfection with HIV and HBV is a growing global health concern.
- Liver disease is a major cause of illness and death in people with HIV, especially those with viral hepatitis.
- Understanding the benefits and risks of dual-acting agents is crucial for effective treatment.
Purpose of the Study:
- To address unresolved issues in managing HIV/HBV coinfection.
- To guide treatment decisions regarding liver biopsy, aminotransferase levels, HBV DNA thresholds, and treatment endpoints.
- To outline therapeutic strategies for HBV when HIV treatment is not yet indicated.
Main Methods:
- Review of current treatment guidelines and available agents for HIV/HBV coinfection.
- Analysis of factors influencing treatment initiation, such as fibrosis and HBV DNA levels.
- Discussion of therapeutic options including pegylated interferon, adefovir, and early antiretroviral therapy.
Main Results:
- Treatment of HBV is recommended for coinfected individuals with significant fibrosis (>=F2) or elevated HBV DNA (>2000 IU/mL).
- The primary goal of therapy is sustained suppression of HBV DNA to undetectable levels.
- Lifelong treatment for HBV is currently recommended in coinfected patients.
- Antiretroviral therapy regimens for coinfected individuals requiring treatment should include two agents with anti-HBV activity.
Conclusions:
- Effective management of HIV/HBV coinfection necessitates a comprehensive approach, considering individual patient factors and available therapeutic options.
- Close monitoring for treatment failure and hepatic flares is essential.
- Further research into novel anti-HBV agents is needed to improve outcomes for coinfected individuals.
Abstract:
Coinfection with HIV and hepatitis B virus (HBV) has become a significant global health problem. Liver disease is now one of the leading causes of morbidity and mortality in individuals with HIV, particularly those with viral hepatitis. There are a number of agents available with dual activity against HIV and HBV, and effective treatment depends on understanding the potential advantages and pitfalls in using these agents. There are a number of unresolved issues in the management of HIV/HBV coinfection. These include the role of liver biopsy, the significance of normal aminotransferase levels, serum HBV DNA threshold for treatment, treatment end-points, and the treatment of HBV when HIV does not yet require treatment. Treatment of HBV should be considered in individuals with HIV/HBV coinfection with evidence of significant fibrosis (>/=F2), or with elevated serum HBV DNA levels (>2000 IU/mL). Sustained suppression of serum HBV DNA to below the level of detection by the most sensitive available assay should be the goal of therapy, and, at present, treatment of HBV in HIV/HBV coinfection is lifelong. If antiretroviral therapy is required, then two agents with anti-HBV activity should be incorporated into the regimen. If antiretroviral therapy is not required, then the options are pegylated interferon, adefovir or the early introduction of antiretroviral therapy. Close monitoring is necessary to detect treatment failure or hepatic flares, such as immune reconstitution disease. Further studies of newer anti-HBV agents in individuals HIV/HBV coinfection may advance treatment of this important condition.
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