Emerging Challenges in Managing Hepatitis B in HIV Patients
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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.
KeywordsHBV Hepatitis B HIV Coinfection Tenofovir Lamivudine Drug resistance Hepatitis delta Vaccine
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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.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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