Antiretroviral therapy in coinfected patients: viral hepatitis and tuberculosis.
OBJECTIVE
Highly active antiretroviral therapy in coinfected patients is complicated by a potentially increased risk for hepatotoxicity. Therefore, treatment strategies are urgently needed.


RESULTS
In HIV/hepatitis B virus coinfected patients with an indication for therapy for both HIV and hepatitis B, tenofovir plus lamivudine or emtricitabine containing highly active antiretroviral therapy regimens are the favored first-line treatment as they include medications which are dually active. Although highly active antiretroviral therapy has no direct effect on hepatitis C replication, the associated immune restoration appears to slow down the progression of liver fibrosis. In patients with HIV and tuberculosis coinfection without any prior highly active antiretroviral therapy, delay of initiation of antiviral therapy for 4-8 weeks after initiation of tuberculosis treatment allows for a better discrimination of causes of adverse events and paradoxical reactions.


CONCLUSIONS
With the introduction of new medications for treatment of hepatitis B virus, therapeutic options for HIV/hepatitis B virus coinfected patients have improved considerably. Initiation of highly active antiretroviral therapy may be a promising option for slowing down further progression of hepatitis C-associated liver disease. Simultaneous treatment of tuberculosis and HIV infection remains a therapeutic challenge requiring specific knowledge of drug-drug interactions as well as management strategies for possible immune reconstitution syndromes.
Department of Medicine I, University of Bonn, D-53105 Bonn, Germany. rockstroh@uni-bonn.de
Jürgen Kurt
JK
Rockstroh
W David
WD
Hardy