Management of Patients Coinfected with Hepatitis B Virus and HIV

The management of chronic hepatitis B virus (HBV) infection poses specific problems in the presence of HIV co-infection, since therapeutic approaches have to consider both HBV and HIV infections.

There are currently four drugs approved for the treatment of chronic HBV infection:  standard interferon alfa (Intron A), peginterferon alfa-2a (Pegasys), lamivudine (Epivir-HBV), adefovir (Hepsera), and entecavir (Baraclude).

The dual antiviral activity of tenofovir and emtricitabine broadens the armamentarium against HBV in HBV-HIV coinfected patients. Nucleotide analogues (the nucleotide analogues adefovir and tenofovir have the advantage of a higher genetic barrier to the development of resistance compared with nucleoside analogues lamivudine and emtricitabine.

Fortunately, the two families do not share resistance mutations, allowing salvage therapy and the possibility of combination therapy for drug-naive individuals.

Although response to standard interferon alfa is poorer in HBV-HIV coinfected patients compared with HIV-negative individuals, especially in hepatitis B e antigen-negative HBV infection, the more potent pegylated forms of interferon alfa now available have brought new hope for greater success with use of this immunotherapy.

Service of Infectious Diseases, Hospital Carlos III, Madrid, Spain.

Chart of Experimental and Approved Therapies for Hepatitis B

09-26-05

Reference
M Nunez and V Soriano. Management of patients co-infected with hepatitis B virus and HIV. Lancet Infectious Diseases 5(6): 374-382. June 2005.