Epidemiology, Diagnosis, and Treatment of Chronic Hepatitis B in HIV Positive Patients

By Liz Highleyman

Due to overlapping routes of transmission, many HIV positive individuals have also been exposed to hepatitis B virus (HBV). Studies suggest that as many as 70%-90% of HIV positive people have evidence of past or current HBV infection. Since a majority of patients spontaneously clear HBV without treatment, however, the rate of active infection is much lower.

In the June 2007 issue of AIDS, French researchers reported data from a study assessing the characteristics of HBV infection in HIV positive patients and the impact of anti-HBV treatment in this population.

The study included all patients with past or present HBV infection seen in October 2005 at 17 French hospitals. Data were retrospectively collected from the first visit in a time-dependent manner using a standardized questionnaire.

Results

• Among 477 HBV-infected patients, 261 (55%) were coinfected with HIV.

• The HIV-HBV coinfected patients underwent fewer serological, virological, and histological evaluations.

• Coinfected patients were more likely to have initial detectable serum hepatitis B "e" antigen (HBeAg) (57.9% vs 28.6%).

• Coinfected individuals were also more likely to have cirrhosis on their initial liver biopsy (17.9% vs 7.6%; P = 0.05).

• During the mean 5-year follow-up period, HBeAg loss and HBe seroconversion were less frequent in the coinfected patients compared to those with HBV alone (incidence rate 2.6 vs 10 per 100 patient-years).

• Patients who experienced HBeAg loss had improved liver fibrosis progression (-0.5 change in METAVIR score) compared to those with persistent detectable HBeAg (+ 0.2 change) (P = 0.01).

• Among coinfected patients treated with tenofovir (Viread), adefovir (Hepsera), or interferon, HBeAg seroconversion was seen in those on combination anti-HBV therapy (used by 58% in 2005).

• However, no significant differences in virological, immunological, or biochemical response were observed among these different treatments.

Conclusion

In conclusion, the authors wrote, "In HBV-HIV coinfected patients, the assessment of HBV infection still needs to be improved, the HBV wild-type remains predominant, and HBeAg loss is rare and associated with a better histological evolution."

They added that at this time, "there is insufficient evidence of the superiority of combined HBV treatment," and said this still needs be demonstrated in long-term studies.

07/03/07

Reference
L Piroth, D Sene, S Pol, and others. Epidemiology, diagnosis and treatment of chronic hepatitis B in HIV-infected patients (EPIB 2005 STUDY). AIDS 21(10): 1323-1331. June 2007.