HIV-HBV Coinfection—Current Challenges for Virologic Monitoring

Abstract

HIV-HBV coinfected patients have higher rates of liver-related morbidity, hospitalizations, and mortality compared to HBV or HIV mono-infected ones. Clinical studies have shown an accelerated progression of liver fibrosis and an increased incidence of HCC, resulting from the combined action of HBV replication, immune-mediated hepatocytolysis, and HIV-induced immunosuppression and immunosenescence. Antiviral therapy based on dually active antiretrovirals is highly efficient, but late initiation, global disparities in accessibility, suboptimal regimens, and adherence issues may limit its impact on the development of end-stage liver disease. In this paper, we review the mechanisms of liver injuries in HIV-HBV coinfected patients and the novel biomarkers that can be used for treatment monitoring in HIV-HBV coinfected persons: markers that assess viral suppression, markers for liver fibrosis evaluation, and predictors of oncogenesis.

FibroScan® versus Biochemical Scores: A Study of Liver Fibrosis in HIV with HBV Co-Infection

“…In HIV patients, liver stiffness increases with advanced AIDS stages, peaking at stage C3. For HIV+HBV patients, higher elastography scores were seen across all stages, suggesting HBV co-infection exacerbates liver disease [ 39 , 40 ]. The highest scores in stage A2 suggest a nonlinear relationship between liver stiffness and AIDS stages in co-infected patients.…”

“…HIV infection activates the immune system through constant viral replication and bacterial translocation, which, although weakened, is strong enough to sustain liver damage that finally leads to fibrosis [ 40 , 43 ].…”

“…Both viruses can directly affect liver cells, with HIV enhancing fibrogenesis and HBV leading to cell death and regeneration in chronic infections [ 39 ]. Some antiretroviral drugs used to treat HIV have hepatotoxic potential and may cause more damage to the liver in the presence of HBV [ 39 , 40 ]. Additionally, when patients initiate ART to treat HIV, they may experience an inflammatory response as the immune system recovers (immune reconstitution inflammatory syndrome), which can worsen liver inflammation in the presence of underlying HBV infection.…”

Non-Invasive Prediction Scores for Hepatitis B Virus- and Hepatitis D Virus-Infected Patients—A Cohort from the North-Eastern Part of Romania

“…Non-invasive scores should always be considered for monitoring patients with chronic hepatitis B and hepatitis D, but only when associated with other diagnosis methods. For instance, combining indexes based on serum markers with imaging-based techniques (transient elastography or vibration-controlled transient elastography) may significantly increase their diagnosis accuracy (EASL) [33].…”