Current therapy for hepatitis C or D or immunodeficiency virus concurrent infection with chronic hepatitis B

Abstract

Concurrent hepatitis C virus (HCV), hepatitis delta virus (HDV), or human immunodeficiency virus (HIV) infection with chronic hepatitis B virus (HBV) appears to increase the risk of progressive liver disease including liver cirrhosis and hepatocellular carcinoma. There is a 10% prevalence of HCV infection in chronic HBV or HDV infection. Serological evidence of previous exposure to HBV is found in more than 80% of HIVpositive patients in the high risk group. Notably, the most recently acquired virus tends to suppress the pre-existing virus. In chronic HBV infection acquired perinatally or in early childhood, usually HCV is dominant and may suppress or even displace HBV and HDV. Less frequently, HBV or HDV suppresses HCV. It is generally agreed that the dominant virus should be identified in order to make appropriate treatment decisions. Studies with standard interferon (IFN) to treat patients with HCV dominantly dual HBV/HCV infection have showed only limited virological response. But high dose of IFN has been demonstrated with better response rate. Combined ribavirin with standard or pegylated IFN therapy could achieve a sustained HCV clearance rate comparable with those infected with HCV alone. On the contrary, patients with HBV dominantly dual viral infection might indicate more appropriate addition of lamivudine to IFN than ribavirin. Additionally, patients with concurrent infection of HBV and HDV, IFN seems to be the only effective agent. However, the efficacy of IFN is related to the dose. High dose of IFN [9 MU tiw (thrice per week)] and longer treatment duration (at least 2 years) have been shown to achieve adequate virological response. In patients with concurrently infected HBV and HIV, anti-HBV therapy should be considered for all patients with evidence of liver disease, irrespective of the CD4 cell count. In patients not requiring antiretroviral therapy, HBV therapy should be preferentially based on IFN, adefovir, or telbivudine. In contrast, in patients with CD4 cell counts \350 cells/ll or those already on antiretroviral therapy, agents with double anti-HBV and anti-HIV activity are preferred. At present, the evidence of therapeutic efficacy is not sufficient to make a recommendation in treating patients with dual HBV/HCV or HBV/HDV or HBV/HIV infection. Further studies of the well-designed, larger scale are needed to elucidate the role of different regimens or combination in the treatment of dual viral infection.

Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update

“…Therefore, concurrent infection with these viruses may occur and complicate the natural course of chronic HBV infection. In general, concurrent infection with these viruses usually results in more severe and progressive liver disease and thus needs treatment [39].…”

JSH Guidelines for the Management of Hepatitis B Virus Infection

“…Meanwhile, studies comparing IFN plus lamivudine combination therapy with IFN monotherapy found similar therapeutic effects 8,22,104 and similar persistent benefits. 96,105,106 IFN in combination with adefovir was likewise found to have roughly the same therapeutic effect six months after treatment as IFN alone. 107 It has been reported that Peg-IFN in combination with entecavir or adefovir produces better negative conversion of HBsAg and reduction in cccDNA levels.…”

“…IFN administered in combination with lamivudine produces improved HBV DNA negative conversion and ALT normalization outcomes compared to lamivudine alone, for both HBeAg positive and negative patients. Meanwhile, studies comparing IFN plus lamivudine combination therapy with IFN monotherapy found similar therapeutic effects and similar persistent benefits . IFN in combination with adefovir was likewise found to have roughly the same therapeutic effect six months after treatment as IFN alone .…”

Recent Advances in the Management of Chronic Hepatitis B Including Suppression of Hepatocellular Carcinoma by Entecavir and Interferon

“…Earlier studies showed that HBV genotypes A and B had a better response to IFN and PEG IFN treatment than genotypes D and C, respectively [57]. Patients with genotype C had a lower response than those with genotype B when treated with a lower dosage of PEG IFN-α 2a (90 μg) or for a shorter duration (24 weeks) [52].…”