Considerations for Antiretroviral Use in Patients with HBV/HIV Coinfection

Hepatitis B virus (HBV) is the leading cause of chronic liver disease worldwide. Globally, approximately 10% of HIV-infected patients have evidence of chronic HBV infection. Persons with HIV infection are at increased risk for developing chronic HBV infection. Compared with HIV-uninfected individuals, those with HIV/HBV coinfection have higher levels of HBV viremia and lower likelihood of resolved infection following acute HBV infection. In HIV/HBV coinfection, monitoring and treatment are also focused on the simultaneous treatment of both viruses. The ultimate treatment goals in HIV/HBV coinfection are the same as for HBV monoinfection: to prevent disease progression and to reduce HBV-related morbidity and mortality. HIV/HBV coinfected patients should receive tenofovir disoproxil fumareate (TDF)- or tenofovir alafenamide (TAF)-based ART. Because both tenofovir and emtricitabine have anti-HBV activity, the combination is also the treatment of choice for HIV/HBV coinfected patients regardless of CD4 and HBV DNA level. Patients receiving ART should continue HBV therapy indefinitely (because relapses after response occur, particularly in those with lower CD4 cell counts and because reports of hepatitis flares after discontinuation of 3TC in those who have not reached treatment endpoints can be extrapolated to other HBV-active drugs. Additionally, discontinuation of nucleos(t)ide analogue therapy is associated with a HBV flare in approximately 30% of cases with loss of the benefit accrued from previous anti-HBV treatment and possible decompensation of liver disease. In order to prevent emergence of drug-resistant variants and evaluate response for patients on nucleos(t)ide analogues, treatment response should be monitored by testing for HBV DNA at 3 to 6 month intervals. Patients co-infected with HIV are at increased risk of HCC and some experts perform HCC screening on HIV/HBV infected patients over 40 years of age.

Keywords:

Hepatitis B Virus , Human Immunodeficiency Virus , Coinfection , Antiretroviral