Hepatitis B Virus and HIV Co-infection: Results of a Survey on Treatment Practices and Recommendations for Therapy

"The management of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection is challenged by the selection of patients for therapy, options for antiviral medication, and inconsistency in published treatment guidelines," explained the authors of the current study, who surveyed 161 sites in a multicenter HIV clinical trials group to assess HBV screening, criteria for start of therapy, and treatment choices for patients co-infected with HIV and HBV.

Of 161 sites, 78 completed the survey for a response rate of 48.4 percent. Of these, 98.7 percent screened for HBV infection, 86 percent vaccinated HIV-positive patients who were not immune to HBV infection, and 79 percent made treatment decisions without referral to a hepatologist or gastroenterologist.

Treatment recommendations varied at the sites. Forty-two percent of the sites initiated therapy when patients' levels of alanine aminotransferase and aspartate aminotransferase were elevated and HBV DNA level was >105 copies/mL, whereas 49 percent started therapy in the presence of any detectable HBV DNA level. Antiviral treatment choices for patients who were not concurrently receiving antiretroviral therapy (ART) were lamivudine plus tenofovir, adefovir or interferon. Patients concurrently receiving ART received lamivudine plus tenofovir preferentially, followed by tenofovir plus emtricitabine, adefovir or interferon. Screening for hepatocellular carcinoma was performed by 91 percent of the sites.

"The majority of HIV-infected patients were screened and vaccinated for HBV infection and underwent surveillance for hepatocellular carcinoma. Decisions regarding the performance of liver biopsy, threshold to initiate therapy, and criteria to discontinue therapy varied, reflecting inconsistencies in available treatment guidelines," the researchers concluded. "Treatment decisions reflected concerns regarding future drug resistance in patients who are naïve to [ART] and the emergence of drug resistance in patients receiving [ART]."

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