Skip to main content

Advertisement

SpringerLink
Log in

Emerging Challenges in Managing Hepatitis B in HIV Patients

  • Co-infections and Comorbidity (S Naggie, Section Editor)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Roughly 10 % of HIV-positive individuals worldwide have concomitant chronic hepatitis B virus (HBV) infection, with large differences between geographical regions and/or risk groups. Hepatitis B is a preventable infection with vaccines. However, it cannot be eradicated once acquired, resembling HIV and in contrast with HCV. In developed countries, hepatitis B exhibits particular features in the HIV population. First, HBV infection is less frequently misdiagnosed than in the general population. Second, nucleos(t)ide analogs active against HBV are widely used as part of antiretroviral combinations and are taken by most HIV patients. Lastly, as the HIV population ages given the success of antiretroviral therapy, non-AIDS co-morbidities are becoming a major cause of disease, for which specific drugs are required, increasing the risk of interactions and hepatotoxicity. Furthermore, concern on HBV reactivation is rising as immunosuppressive drug therapies are increasingly been used for cancers and other non-malignant conditions. In this scenario, new challenges are emerging in the management of hepatitis B in HIV-positive individuals. Among them, major interest is focused on failures to suppress HBV replication, HBV breakthroughs and reactivations, the meaning of isolated anti-HBc, screening for liver cancer, and the complexity arising when hepatitis viruses C and/or D are additionally present. This review will focus on these challenges and the major advances in HBV coinfection in HIV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Soriano V, Puoti M, Peters M, et al. Care of HIV patients with chronic hepatitis B: updated recommendations from the HIV-Hepatitis B virus international panel. AIDS. 2008;22:1399–410.

    Article  PubMed  Google Scholar 

  2. Thio C. Hepatitis B, and Human immunodeficiency virus coinfection. Hepatology. 2009;49(suppl):138–45.

    Article  Google Scholar 

  3. Soriano V, de Mendoza C, Fernandez-Montero JV, Labarga P, Barreiro P. Management and treatment of chronic hepatitis B in HIV-positive patients. Ann Med. 2014;46:290–6.

    Article  CAS  PubMed  Google Scholar 

  4. Kellerman S, Hanson D, McNaghten A, Fleming P. Prevalence of chronic hepatitis B and incidence of acute hepatitis B infection in HIV-infected participants. J Infect Dis. 2003;188:571–7.

    Article  PubMed  Google Scholar 

  5. Konopnicki D, Mocroft A, de Wit S, et al. Hepatitis B and HIV: prevalence, AIDS progression, response to HAART and increased mortality in the EuroSIDA cohort. AIDS. 2005;19:2117–25.

    Article  Google Scholar 

  6. WHO. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. March 2015 (www.who.int) This document is an updated comprehensive report on the prevention, management and treatment of hepatitis B, with special focus on developing regions. Non-invasive methods for assessing liver fibrosis are overtly recommended instead of liver biopsies whereas tenofovir or entecavir are preferred over lamivudine as HBV therapy.

  7. Modi A, Feld J. Viral hepatitis and HIV in Africa. AIDS Rev. 2007;9:25–39. This is one of the most comprehensive reviews on the epidemiology of viral hepatitis in Africa and its overlap with the HIV epidemic.

  8. Geretti AM, Patel M, Sarfo F, et al. Detection of highly prevalent HBV co-infection among HIV-seropositive persons in Ghana. J Clin Microbiol. 2010;48:3223–30.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Chun H, Fieberg A, Hullsied K, et al. Epidemiology of Hepatitis B virus infection in a US cohort of HIV-infected individuals during the past 20 years. Clin Infect Dis. 2010;50:426–36.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Te H, Jensen D. Epidemiology of hepatitis B and C viruses: a global overview. Clin Liver Dis. 2010;14:1–21.

    Article  PubMed  Google Scholar 

  11. Trepo C, Chan H, Lok A. Hepatitis B virus infection. Lancet. 2014;384:2053–63.

    Article  CAS  PubMed  Google Scholar 

  12. European AIDS Clinical Society Guidelines. Version 7.0. October 2013. Available at http://www.europeanaidsclinicalsociety.org. Accessed on April 27th 2015.

  13. DHHS. Recommendations for use of antiretroviral drugs in HIV-1-infected adults and adolescents. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/.pdf. Accessed on April 27th 2015.

  14. Gunthard H, Aberg J, Eron J, et al. Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA panel. JAMA. 2014;312:410–25.

    Article  PubMed  Google Scholar 

  15. Thio C, Seaberg E, Skolasky R, et al. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet. 2002;360:1921–6. This is a pivotal study demonstrating that HIV worsts the natural history of chronic hepatitis B.

  16. Buti M, Tsai N, Petersen J, Flisiak R, Gurel S, Krastev Z, et al. Seven-year efficacy and safety of treatment with tenofovir disoproxil fumarate for chronic hepatitis B virus infection. Dig Dis Sci (in press).

  17. Martín-Carbonero L, Teixeira T, Poveda E, et al. Clinical and virological outcomes in HIV-infected patients with chronic hepatitis B on long-term nucleos(t)ide analogues. AIDS. 2011;25:73–9. This study reports HBV outcomes in one of the largest series of HIV-HBV coinfected individuals followed for the longest follow-up on tenofovir-containing regimens.

  18. Koklu S, Tuna Y, Gulsen M, et al. Long-term efficacy and safety of lamivudine, entecavir, and tenofovir for treatment of hepatitis B virus-related cirrhosis. Clin Gastroenterol Hepatol. 2013;11:88–94.

    Article  CAS  PubMed  Google Scholar 

  19. Boyd A, Gozlan J, Maylin S, et al. Persistent viremia in human immunodeficiency virus/hepatitis B coinfected patients undergoing long-term tenofovir: virological and clinical implications. Hepatology. 2014;60:497–507. This study reported a 10% rate of low-level HBV-DNA in 111 HIV-HBV coinfected patients treated with tenofovir and followed for more than 6 years.

  20. Sheldon J, Camino N, Rodes B, et al. Selection of hepatitis B virus polymerase mutations in HIV coinfected patients treated with tenofovir. Antivir Ther. 2005;10:727–34.

    CAS  PubMed  Google Scholar 

  21. Liu Y, Fung S, Gane E, et al. Evaluation of HBV-DNA decay kinetics in patients containing both rtM204V/I mutant and wild-type HBV subpopulations during tenofovir DF (TDF) monotherapy or combination therapy with emtricitabine (FTC)/TDF. J Med Virol. 2014;86:1473–81.

    Article  CAS  PubMed  Google Scholar 

  22. Fung S, Kwan P, Fari M, et al. Randomized comparison of tenofovir vs emtricitabine and tenofovir in patients with lamivudine-resistant chronic hepatitis B. Gastroenterology. 2014;146:980–8.

    Article  CAS  PubMed  Google Scholar 

  23. Corsa A, Liu Y, Flaherty J, et al. No resistance to tenofovir disoproxil fumarate through 96 weeks of treatment in patients with lamivudine-resistant chronic hepatitis B. Clin Gastroenterol Hepatol (in press).

  24. Plaza Z, Aguilera A, Mena A, et al. Influence of HIV infection on response to tenofovir in patients with chronic hepatitis B. AIDS. 2013;27:2219–24.

    Article  CAS  PubMed  Google Scholar 

  25. Boyd A, Moh R, Gabillard D, et al. Low risk of lamivudine-resistant HBV and hepatic flares in treated HIV-HBV co-infected patients from Cote d’Ivoire. Antivir Ther 2015 (in press).

  26. Hoffmann C, Charalambous S, Martin D, et al. Hepatitis B virus infection and response to antiretroviral therapy (ART) in a South African ART program. Clin Infect Dis. 2008;47:1479–85.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Soriano V, Rivas P, Nuñez M. Risks and benefits of using antiretroviral therapy in HIV-infected patients with chronic hepatitis B in developing regions. Clin Infect Dis. 2008;47:1486–9.

    Article  PubMed  Google Scholar 

  28. Thibault V, Aubron-Olivier C, Agut H, Katlama C. Primary infection with a lamivudine-resistant hepatitis B virus. AIDS. 2002;16:131–3.

    Article  PubMed  Google Scholar 

  29. Tuma P, Pineda J, Labarga P, et al. HBV primary drug resistance in newly diagnosed HIV-HBV-coinfected individuals in Spain. Antivir Ther. 2011;16:585–89.

    Article  PubMed  Google Scholar 

  30. Kouanfack C, Aghokeng A, Mondain A, et al. Lamivudine-resistant HBV infection in HIV-positive patients receiving antiretroviral therapy in a public routine clinic in Cameroon. Antivir Ther. 2012;17:321–6.

    Article  CAS  PubMed  Google Scholar 

  31. Velasco M, Morán A, Téllez MJ. Resolution of chronic hepatitis B after ritonavir treatment in an HIV-infected patient. N Engl J Med. 1999;340:1765–6.

    Article  CAS  PubMed  Google Scholar 

  32. Crane M, Oliver B, Matthews G, Avihingsanon A, Ubolyam S, Markovska V, et al. Immunopathogenesis of hepatic flare in HIV/HBV-coinfected individuals after the initiation of HBV-active antiretroviral therapy. J Infect Dis. 2009;199:974–81.

    Article  CAS  PubMed  Google Scholar 

  33. Soriano V, Puoti M, Garcia-Gascó P, et al. Antiretroviral drugs and liver injury. AIDS. 2008;22:1–13.

    Article  PubMed  Google Scholar 

  34. Dore G, Soriano V, Rockstroh J, Kupfer B, Tedaldi E, Peters L, et al. Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected patients following antiretroviral therapy interruption. AIDS. 2010;24:857–65.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Berg T, Simon K, Mauss S, Schott E, Heyne R, Klass D, et al. Stopping tenofovir treatment after long-term virologic suppression in HBeAg-negative CHB: week 48 interim results from an ongoing randomized, controlled trial (FINITE CHB) [abstract O-119]. J Hepatol. 2015;62(suppl):253.

    Article  Google Scholar 

  36. Labarga P, Barreiro P, Martin-Carbonero L, et al. Kidney tubular abnormalities in the absence of impaired glomerular function in HIV patients treated with tenofovir. AIDS. 2009;23:689–96.

    Article  CAS  PubMed  Google Scholar 

  37. Del Palacio M, Romero S, Casado JL. Proximal tubular renal dysfunction or damage in HIV-infected patients. AIDS Rev. 2012;14:179–87.

    PubMed  Google Scholar 

  38. Rifkin B, Perazella M. Tenofovir-associated nephrotoxicity: Fanconi syndrome and renal failure. Am J Med. 2004;117:282–4.

    Article  CAS  PubMed  Google Scholar 

  39. Karras A, Lafaurie M, Furco A, et al. Tenofovir-related nephrotoxicity in HIV-infected patients: three cases of renal failure, Fanconi syndrome, and nephrogenic diabetes insipidus. Clin Infect Dis. 2003;36:1070–3.

    Article  PubMed  Google Scholar 

  40. Bedimo R, Maalouf N, Zhang S, Drechsler H, Tebas P. Osteoporotic fracture risk associated with cumulative exposure to tenofovir and other antiretroviral agents. AIDS. 2012;26:825–31.

    Article  CAS  PubMed  Google Scholar 

  41. Wands J, Chura C, Roll F, et al. Serial studies of hepatitis-associated antigen and antibody in patients receiving antitumor chemotherapy for myeloproliferative and lymphoproliferative disorders. Gastroenterology. 1975;68:105–12.

  42. Perrillo R, Martin P, Lok A. Preventing hepatitis B reactivation due to immunosuppressive drug regimens. JAMA (in press). This editorial briefly updates which circumstances may prone to hepatitis B reactivation and how to prevent it.

  43. Yeo W, Johnson P. Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology. 2006;43:209–20.

    Article  CAS  PubMed  Google Scholar 

  44. Seto W, Chan T, Hwang Y, Wong D, Liu K, Gill H, et al. A prospective study of hepatitis B reactivation in patients with prior HBV exposure undergoing hematopoietic stem cell transplantation: reactivation association with graft-versus-host disease [abstract O-009]. J Hepatol. 2015;62(suppl):194.

    Article  Google Scholar 

  45. Milazzo L, Ebranati E, Cattaneo D, et al. Recurrence of another hepatitis B virus escape mutant comes back in a patient infected with HIV and low CD4+ count. J Med Virol. 2014;86:97–101.

    Article  CAS  PubMed  Google Scholar 

  46. Pei R, Grund S, Verheyen J, Esser S, Chen X, Lu M. Spontaneous reactivation of hepatitis B virus replication in an HIV coinfected patient with isolated anti-hepatitis B core antibodies. Virol J. 2014;11:9.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Soriano V, McMahon B. Strategic use of lamivudine in the management of chronic hepatitis B. Antivir Res. 2013;100:435–8.

    Article  CAS  PubMed  Google Scholar 

  48. McMahon B, Jilek B, Brennan T, et al. The HBV drug entecavir—effects on HIV-1 replication and resistance. N Engl J Med. 2007;356:2614–21. This was the first report of the unexpected weak antiretroviral effect of entecavir and the risk for selection of drug resistance mutations in HIV.

  49. Koskinas J, Tampaki M, Doumba P, Rallis E. Hepatitis B virus reactivation during therapy with ustekinumab for psoriasis in a HBsAg-negative anti-HBs + patient. Br J Dermatol. 2013;168:679–80.

    Article  CAS  PubMed  Google Scholar 

  50. López-Serrano P, de la Fuente E, Carrera E, Pérez-Calle J, Fernández C. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: when and how to apply prophylaxis, with a special focus on corticosteroid therapy. World J Hepatol. 2015;7:539–47.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Tamori A, Koike T, Goto H, Wakitani S, Tada M, Morikawa H, et al. Prospective study of reactivation of HBV in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts. J Gastroenterol. 2011;46:556–64.

    Article  CAS  PubMed  Google Scholar 

  52. Lok A, McMahon B. Chronic hepatitis B: update 2009. Hepatology. 2009;50:661–96.

    Article  PubMed  Google Scholar 

  53. Lok A. Personalized treatment of hepatitis B. Clin Mol Hepatol. 2015;21:1–6.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Kane M. Global programme for control of hepatitis B infection. Vaccine. 1995;13(suppl):47–9.

    Article  Google Scholar 

  55. World Health Organization. Hepatitis B vaccines: WHO position paper. Wkly Epidemiol Rec. 2009;84:405–19.

    Google Scholar 

  56. Rivas P, Herrero MD, Puente S, Ramírez-Olivencia G, Soriano V. Immunizations in HIV-infected adults. AIDS Rev. 2007;9:173–87.

    PubMed  Google Scholar 

  57. Fonseca M, Pang L, de Paula-Cavalheiro N, Barone A, Heloisa-Lopes M. Randomized trial of recombinant hepatitis B vaccine in HIV-infected adult patients comparing a standard dose to a double dose. Vaccine. 2005;23:2902–8.

    Article  CAS  PubMed  Google Scholar 

  58. Launay O, van der Vliet D, Rosenberg A, et al. Safety and immunogenicity of 4 intramuscular double doses and 4 intradermal low doses vs standard hepatitis B vaccine regimen in adults with HIV-1: a randomized controlled trial. JAMA. 2011;305:1432–40.

    Article  CAS  PubMed  Google Scholar 

  59. Roni D, Pathapati R, Kumar A, Nihal L, Sridhar K, Tumkur RS. Safety and efficacy of hepatitis B vaccination in cirrhosis of liver. Adv Virol. 2013;20:196704.

    Google Scholar 

  60. Witt M, Lewis R, Rieg G, Seaberg E, Rinaldo C, Thio C. Predictors of the isolated hepatitis B core antibody pattern in HIV-infected and -uninfected men in the multicenter AIDS cohort study. Clin Infect Dis. 2013;56:606–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Gandhi R, Wurcel A, Lee H, et al. Response to hepatitis B vaccine in HIV-1-positive subjects who test positive for isolated antibody to hepatitis B core antigen: implications for hepatitis B vaccine strategies. J Infect Dis. 2005;191:1435–41.

    Article  CAS  PubMed  Google Scholar 

  62. Wang Q, Semmo N. T and B cell responses and previous exposure to hepatitis B virus in “anti-HBc alone” patients [abstract O-010]. J Hepatol. 2015;62(suppl):194–5.

    Article  Google Scholar 

  63. Locarnini S, Hatzakis A, Chen D, Lok A. Strategies to control hepatitis B: public policy, epidemiology, vaccine and drugs. J Hepatol. 2015;62(suppl):76–86.

    Article  Google Scholar 

  64. Whitaker J, Rouphael N, Edupuganti S, Lai L, Mulligan M. Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1. Lancet Infect Dis. 2012;12:966–76.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Chen C, Yang H, Su J, et al. Risk of hepatocellular carcinoma across biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65–73. This manuscript derives from the REVEAL-HBV study and reported for the first time a strong positive direct correlation between baseline serum HBV-DNA and the risk of liver cancer in chronic hepatitis B patients.

  66. Wu C, Lin J, Ho H, Su C, Lee T, Wang S, et al. Association of nucleoside analogue therapy with reduced risk of hepatocellular carcinoma in patients with chronic hepatitis B—a nationwide cohort study. Gastroenterology. 2014;147:143–51.

    Article  CAS  PubMed  Google Scholar 

  67. Clifford G, Rickenbach M, Polesel J, et al. Influence of HIV-related immunodeficiency on the risk of hepatocellular carcinoma. AIDS. 2008;22:2135–41.

    Article  CAS  PubMed  Google Scholar 

  68. Fernández-Montero JV, Soriano V. Management of hepatitis C in HIV and/or HBV co-infected patients. Best Pract Res Clin Gastroenterol. 2012;26:517–30.

    Article  PubMed  Google Scholar 

  69. Zhou J, Dore G, Zhang F, Lim P, Chen Y, Asia TREAT, et al. Hepatitis B and C virus coinfection in the TREAT Asia Observational database. J Gastroenterol Hepatol. 2007;22:1510–8.

    Article  PubMed  Google Scholar 

  70. Pontisso P, Ruvoletto M, Fattovich G, Chemello L, Callorini A, Ruol A, et al. Clinical and virological profiles in patients with multiple hepatitis virus infections. Gastroenterology. 1993;105:1529–33.

    Article  CAS  PubMed  Google Scholar 

  71. Chu C, Lee S. Hepatitis B virus/hepatitis C virus coinfection: epidemiology, clinical features, viral interactions and treatment. J Gastroenterol Hepatol. 2008;23:512–20.

    Article  PubMed  Google Scholar 

  72. Soriano V, Barreiro P, Martin-Carbonero L, et al. Treatment of chronic hepatitis B or C in HIV-infected patients with dual viral hepatitis. J Infect Dis. 2007;195:1181–3.

    Article  CAS  PubMed  Google Scholar 

  73. Liu C, Chen P, Lai M, Kao J, Jeng Y, Chen D. Ribavirin and interferon is effective for hepatitis C virus clearance in hepatitis B and C dually infected patients. Hepatology. 2003;37:568–76.

    Article  CAS  PubMed  Google Scholar 

  74. Liu C, Chuang W, Lee C, et al. Peginterferon alfa-2b plus ribavirin for the treatment of dual chronic infection with hepatitis B and C viruses. Gastroenterology. 2009;136:496–504.

    Article  CAS  PubMed  Google Scholar 

  75. Collins J, Raphael K, Terry C, et al. Hepatitis B reactivation during successful treatment of hepatitis C with sofosbuvir and simeprevir. Clin Infect Dis (in press) This study records for the first time two cases of HBV reactivation during successful DAA therapy for hepatitis C.

  76. Wedemeyer H, Heidrich B, Manns M. Hepatitis D virus infection – not a vanishing disease in Europe! Hepatology. 2007;45:1331–2.

    Article  PubMed  Google Scholar 

  77. Soriano V, Grint D, d’Arminio-Monforte A, et al. Hepatitis delta in HIV-infected individuals in Europe. AIDS. 2011;25:1987–92.

    Article  PubMed  Google Scholar 

  78. Calle-Serrano B, Manns M, Wedemeyer H. Hepatitis delta and HIV infection. Semin Liver Dis. 2012;32:120–9.

    Article  PubMed  Google Scholar 

  79. Kew M. Hepatitis viruses (other than hepatitis B and C viruses) as causes of hepatocellular carcinoma: an update. J Viral Hepat. 2013;20:149–57.

    Article  CAS  PubMed  Google Scholar 

  80. Farci P, Niro G. Clinical features of hepatitis D. Semin Liver Dis. 2012;32:228–36.

    Article  PubMed  Google Scholar 

  81. Fernández-Montero JV, Vispo E, Barreiro P, Sierra-Enguita R, de Mendoza C, Labarga P, et al. Hepatitis delta is a major determinant of liver decompensation events and death in HIV-infected patients. Clin Infect Dis. 2014;58:1549–53. This large study highlights the deleterious impact of hepatitis delta on HIV-positive individuals in comparison with coinfection with other hepatitis viruses (B and C).

  82. Erhardt A, Gerlich W, Starke C, et al. Treatment of chronic hepatitis D with pegylated interferon-alpha 2b. Liver Int. 2006;26:805–10.

    Article  CAS  PubMed  Google Scholar 

  83. Yurdaydin C. Treatment of chronic delta hepatitis. Semin Liver Dis. 2012;32:237–44.

    Article  CAS  PubMed  Google Scholar 

  84. Farci P, Roskams T, Chessa L, et al. Long-term benefit of interferon as therapy of chronic hepatitis D: regression of advanced hepatic fibrosis. Gastroenterology. 2004;126:1740–9.

    Article  CAS  PubMed  Google Scholar 

  85. Niro G, Ciancio A, Gaeta G, et al. Pegylated interferon alpha-2b as monotherapy or in combination with ribavirin in chronic hepatitis D. Hepatology. 2006;44:713–20.

    Article  CAS  PubMed  Google Scholar 

  86. Yurdaydin C, Bozkaya H, Onder F, et al. Treatment of chronic D hepatitis with lamivudine vs lamivudine + interferon vs interferon. J Viral Hepat. 2008;15:314–21.

    Article  CAS  PubMed  Google Scholar 

  87. Wedemeyer H, Yurdaydìn C, Dalekos G, HIDIT Study Group, et al. Peginterferon plus adefovir versus either drug alone for hepatitis delta. N Engl J Med. 2011;364:322–31.

    Article  CAS  PubMed  Google Scholar 

  88. Wedemeyer H, Port K, Heidrich S, et al. 96 weeks of pegylated interferon alpha-2a plus tenofovir or placebo for the treatment of hepatitis delta: the HIDIT-2 study. Washington DC: AASLD; 2013 [abstract 31].

  89. Mansour W, Ducancelle A, Le Gal F, et al. Resolution of chronic hepatitis Delta after 1 year of combined therapy with pegylated interferon, tenofovir and emtricitabine. J Clin Virol. 2010;47:97–9.

    Article  CAS  PubMed  Google Scholar 

  90. James G, Sidhu P, Raza M. First report of successful clearance of hepatitis B and D coinfection with tenofovir monotherapy. Hepatology (in press).

  91. Sheldon J, Ramos B, Toro C, et al. Does treatment of hepatitis B virus (HBV) infection reduce hepatitis delta virus (HDV) replication in HIV-HBV-HDV-coinfected patients? Antivir Ther. 2008;13:97–102.

    CAS  PubMed  Google Scholar 

  92. Soriano V, Vispo E, Sierra-Enguita R, et al. Efficacy of prolonged tenofovir therapy on hepatitis delta in HIV-infected patients. AIDS. 2014;28:2389–94.

    Article  CAS  PubMed  Google Scholar 

  93. Soriano V, Barreiro P, de Mendoza C. Tenofovir for hepatitis delta. Hepatology (in press).

  94. Farci P. Treatment of chronic hepatitis D: new advances, old challenges. Hepatology. 2006;44:536–9.

    Article  CAS  PubMed  Google Scholar 

  95. Roche B, Samuel D. Liver transplantation in delta virus infection. Semin Liver Dis. 2012;32:245–55.

    Article  CAS  PubMed  Google Scholar 

  96. Ni Y, Lempp F, Mehrle S, et al. Hepatitis B and D viruses exploit sodium taurocholate co-transporting polypeptide for species-specific entry into hepatocytes. Gastroenterology. 2014;146:1070–83.

    Article  CAS  PubMed  Google Scholar 

  97. Zoulim F, Durantel D. Antiviral therapies and prospects for a cure of chronic hepatitis B. Cold Spring Harb Perspect Med. 2015;5:a021501.

    Article  PubMed  Google Scholar 

  98. Yurdaydin C, Idilman R, Choong I, et al. Optimizing the prenylation inhibitor lonafarnib using ritonavir boosting in patients with chronic delta hepatitis. EASL, Vienna, April 2015 [abstract O118]. J Hepatol. 2015;62(suppl):252.

    Article  Google Scholar 

  99. Schirmera P, Wintersb M, Holodniy M. HIV-HBV vaccine escape mutant infection with loss of HBV surface antibody and persistent HBV viremia on tenofovir/emtricitabine without antiviral resistance. J Clin Virol. 2011;52:261–4.

    Article  Google Scholar 

  100. Pal A, Sarkar N, Saha D, et al. High incidence of lamivudine-resistance associated vaccine-escape HBV mutant among HIV-coinfected patients on prolonged antiretroviral therapy. Antivir Ther (in press).

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Vincent Soriano declares a grant from Instituto de Salud Carlos III for projects ICI14-00372, CES12/003, PI13/01574) and a grant from Fundacion Investigacion y Educacion en SIDA.

Pablo Labarga, Carmen de Mendoza, José M. Peña, José V. Fernández-Montero, Laura Benítez, Isabella Esposito, and Pablo Barreiro declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Infectious Diseases Unit, La Paz University Hospital, Madrid, Spain

    Vincent Soriano, José M. Peña, Isabella Esposito & Pablo Barreiro

  2. Department of Internal Medicine, La Luz Clinic, Madrid, Spain

    Pablo Labarga

  3. Department of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Madrid, Spain

    Carmen de Mendoza & Laura Benítez

  4. Department of Infectious Diseases, Crosshouse University Hospital, Kilmarnock, Scotland, UK

    José V. Fernández-Montero

Authors
  1. Vincent Soriano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pablo Labarga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carmen de Mendoza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. José M. Peña
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. José V. Fernández-Montero
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Laura Benítez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Isabella Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pablo Barreiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vincent Soriano.

Additional information

Key points

Between 5 and 15 % of HIV+ individuals worldwide have chronic hepatitis B, with large differences across geographical regions and/or risk groups.

Hepatitis B is a preventable infection with vaccines. However, if acquired it cannot be eradicated, resembling HIV and in contrast with HCV infection.

Assessment of HBV status is warranted in all HIV+ persons and HBV vaccination should be given to all susceptible individuals.

Coinfection with HCV and HDV must be excluded at least once in all HBsAg+ carriers and ongoing HCV screening recommended for high-risk HIV-positive individuals

Chronic hepatitis B may lead to cirrhosis and liver cancer. HBV-related hepatic disease is accelerated by HIV coinfection. Early use of antivirals improves prognosis.

Treatment of HIV including anti-HBV active agents should be given to all coinfected patients regardless CD4 counts. Tenofovir is the drug of choice due to its dual activity for HIV and HBV. Lamivudine as the only active anti-HBV agent should be discouraged due to high-risk of resistance selection, which decreases sensitivity to entecavir, another first-line HBV nucleoside.

Periodic assessment of liver fibrosis using non-invasive tools (i.e., elastometry) should be performed in HIV-HBV coinfected patients. Screening for hepatocellular carcinoma is warranted in cirrhotics and patients with elevated serum HBV-DNA.

Concerns on HBV reactivation is rising as immunosuppressive drug therapies are increasingly been used for cancers and other non-malignant conditions in an aging HIV population.

This article is part of the Topical Collection on Co-infections and Comorbidity

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soriano, V., Labarga, P., de Mendoza, C. et al. Emerging Challenges in Managing Hepatitis B in HIV Patients. Curr HIV/AIDS Rep 12, 344–352 (2015). https://doi.org/10.1007/s11904-015-0275-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11904-015-0275-7

Keywords

Search

Navigation