Advances in the treatment of hepatitis B virus/hepatitis C virus coinfection.
BACKGROUND
Patients with chronic hepatitis B virus (HBV)/hepatitis C virus (HCV) coinfection are at a high risk of developing liver cirrhosis and hepatocellular carcinoma, and consequently, warrant effective treatment.


METHODS
Effective treatment should eradicate HCV infection and inhibit HBV replication but without serious adverse reactions. Careful evaluation of disease progression, predominance of one virus over another, comorbidities and concomitant hepatitis delta virus and/or HIV infection are essential for better therapy choices. In the case of HCV predominance, Peg-interferon plus ribavirin with or without a first-generation directly acting antiviral (DAA) should be the first choice, but future treatments will be DAA-based and interferon-free. In the case of HBV predominance, tenofovir or entecavir should be part of treatment. Patients should be closely monitored for early identification and treatment of HCV or HBV reactivation.


CONCLUSIONS
High potency and high genetic barrier nucleos(t)ide analogues to inhibit HBV replication have been used for years, with no urgency for new drugs. Several DAAs for interferon-free therapy for HCV eradication will be available in the near future. We hope that the high cost of these drugs will not be a limitation to their use in developing countries. Further investigation of HBV/HCV interaction is needed before and during the administration of new therapies.
Department of Mental Health and Public Medicine, Division of Infectious Diseases, Second University of Naples , Naples , Italy +39 81 5560885 ; +39 81 5666207 ; evangelista.sagnelli@unina2.it , evangelistasagnelli@libero.it.
Evangelista
E
Sagnelli
Mariantonietta
M
Pisaturo
Salvatore
S
Martini
Caterina
C
Sagnelli
Pietro
P
Filippini
Nicola
N
Coppola
D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D060085:Coinfection; D004279:DNA, Viral / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications; D016174:Hepacivirus / Q000187:drug effects* / Q000235:genetics / Q000502:physiology; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000502:physiology; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D063065:Organophosphonates / Q000627:therapeutic use; D012367:RNA, Viral / Q000302:isolation & purification; D012254:Ribavirin / Q000627:therapeutic use; D000068698:Tenofovir; D014779:Virus Replication / Q000187:drug effects
D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D012367:RNA, Viral; D012254:Ribavirin; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000225:Adenine
hepatitis B virus/hepatitis C virus coinfection; hepatitis B virus/hepatitis C virus coinfection treatment; hepatitis B virus/hepatitis C virus epidemiology; hepatitis B virus/hepatitis C virus/HIV interaction