[Hepatitis B in patients with HIV infection].
Chronic hepatitis B virus infection affects approximately 10% of HIV-infected patients. There are an estimated 4 million patients with HIV/HBV coinfection. HIV infection has a deleterious effect on the natural history of chronic hepatitis B and increases the risk of progression to cirrhosis and terminal liver disease. Since the widespread use of highly active antiviral therapy (HAART), liver disease has emerged as one of the main causes of morbidity and mortality in HIV-positive patients. Therefore, all patients with HIV/HBV coinfection should be evaluated for treatment of hepatitis B, independently of the CD4 lymphocyte count. Six drugs are currently authorized for the treatment of chronic hepatitis B: standard interferon-alpha (2a and 2b), pegylated interferon alpha-2a, lamivudine, adefovir, entecavir and telbivudine. Other drugs with activity against HBV, such as tenofovir and emtricitabine, are used for the treatment of HIV infection. In patients not requiring HAART, treatment of hepatitis B should preferably consist of drugs without activity against HIV, such as pegylated interferon or adefovir. In contrast, in patients requiring HAART, a combination of drugs with activity against both viruses should be used, such as lamivudine, emtricitabine and tenofovir, with the aim of achieving maximal viral suppression and avoiding the development of resistance. Patients with HIV/HBV coinfection require periodic clinical and virological monitoring. Patients with cirrhosis should undergo ultrasonography and alphafetoprotein determination every 6 months for the early detection of hepatocellular carcinoma.
Barreiro
Pablo
P
Servicio de Enfermedades Infecciosas, Hospital Carlos III, Madrid, España.
Martín-Carbonero
Luz
L
García-Samaniego
Javier
J
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D024882:Drug Resistance, Viral / Q000235:genetics; D004359:Drug Therapy, Combination; D000068679:Emtricitabine; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D017325:Hepatitis B Vaccines; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use; D009705:Nucleosides / Q000008:administration & dosage / Q000627:therapeutic use; D063065:Organophosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011744:Pyrimidinones / Q000008:administration & dosage / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000077712:Telbivudine; D000068698:Tenofovir; D013936:Thymidine / Q000031:analogs & derivatives; D014779:Virus Replication / Q000187:drug effects
D019380:Anti-HIV Agents; D000998:Antiviral Agents; D017325:Hepatitis B Vaccines; D016898:Interferon-alpha; D009705:Nucleosides; D063065:Organophosphonates; D011744:Pyrimidinones; D018894:Reverse Transcriptase Inhibitors; D003841:Deoxycytidine; D000077712:Telbivudine; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine; C106812:adefovir dipivoxil; D013936:Thymidine