Consensus conference on chronic viral hepatitis and HIV infection: updated Spanish recommendations

Abstract

Chronic hepatitis B and C represent a leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients worldwide. New treatment options against both hepatitis B (HBV) and C (HCV) viruses have prompted us to update previous recommendations for the management of coinfected individuals. Fifteen topics (nine related to HCV, five to HBV and one to both viruses) were selected for this purpose. A panel of Spanish experts in the field was invited to review these areas and propose specific recommendations, which were scored according to the Infectious Disease Society of America (IDSA) grading system. These guidelines represent a comprehensive and updated overview on the management of hepatitis B and C in HIV-infected patients.

The HBV Drug Entecavir — Effects on HIV-1 Replication and Resistance

“…Current guidelines recommend entecavir as the first line treatment in HIV-HBV co-infected persons who do not require anti-HIV therapy (8,9). Since this recommendation is predicated on the assumption that entecavir does not have activity against HIV, our data indicate that this recommendation should be reconsidered, especially since entecavir can select for the M184V mutation in some patients.…”

“…This selective activity against HBV is unique amongst the nucleoside/nucleotide analogues available for hepatitis B treatment (4)(5)(6)(7). Thus, several treatment guidelines, including the United States Public Health Service Guidelines, recommend entecavir for hepatitis B treatment in HIV-infected individuals who do not meet criteria for HIV treatment (8)(9)(10)(11). Here, we report that entecavir has clinically relevant activity against HIV and can select HIV variants resistant to the widely used antiretroviral drugs lamivudine and emtricitabine.…”

HIV coinfection shortens the survival of patients with hepatitis C virus‐related decompensated cirrhosis†

“…8 The protocols currently used for including HIVinfected patients with ESLD in liver transplantation programs consider that the liver disease criteria for transplantation should be the same as those for the general population. 11,37 However, these criteria are based on survival studies performed in patients without HIV infection. At least in the case of HCV-related ESLD, this recommendation may be inappropriate, given the effect that HIV coinfection exerts on the survival of this disease.…”

Clinical progression of hepatitis C virus–related chronic liver disease in human immunodeficiency virus–infected patients undergoing highly active antiretroviral therapy

“…The indication and the therapy schedule were based on the recommendations of consensus panels. [12][13][14] Adherence to therapies was measured by the report of the patients and checked with the pharmacy supply registers.…”