Ultra-long-acting (XLA) antivirals for chronic viral hepatitis

Soriano, Vincent; Alvarez, Carmen; Edagwa, Benson; Mendoza, Carmen de; Montoya, Noemí; Treviño, Ana; Gendelman, Howard E.

doi:10.1016/j.ijid.2021.10.052

Cited by 16 publications

(10 citation statements)

References 33 publications

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“…The subset of patients with hepatitis delta superinfection largely accounts for this worst clinical outcome. Renovate vaccine implementation efforts and much broader use of potent oral antivirals would be needed 29,30 to achieve the WHO goal of viral hepatitis elimination as a public health threat by 2030 9…”

Section: Discussionmentioning

confidence: 99%

Impact of potent nucleos(t)ide therapy on hepatitis B hospitalisations in Spain

Ramos-Rincón

Pinargote‐Celorio

Mendoza

et al. 2022

Aliment Pharmacol Ther

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Summary Background Chronic hepatitis B virus (HBV) infection is a major cause of decompensated cirrhosis and liver cancer worldwide. Newborn HBV vaccination was implemented in Spain two decades ago, and potent oral antivirals entecavir and tenofovir were introduced around 2007. Aim To assess the clinical benefits of these interventions nationwide. Methods Including HBV as a diagnosis, we performed a retrospective study of all hospitalisations in Spain the Spanish National Registry of Hospital Discharges. Information was retrieved from 1997 to 2017. Results From 73,939,642 nationwide hospital admissions during the study period, 129,634 (0.17%) included HBV as diagnosis. Their number doubled from 2007 to 2017 and the median age increased from 44 to 58 years. Most HBV admissions recorded chronic hepatitis B. In‐hospital death occurred in 6.4%. Co‐infection with HIV or hepatitis C virus occurred in 11.9% and 23.3%, respectively. Patients with HIV‐HBV co‐infection had significantly greater mortality than individuals with HBV mono‐infection. The rate of HBV hospitalisations significantly increased over time with a transient drop around 2007, coincident with the arrival of new potent oral antivirals. Although the proportion of HBV hepatic decompensation events has declined, the rate of liver cancer continues to rise. The small subset of patients with hepatitis delta superinfection increasingly and disproportionately accounts for hepatic decompensation events and liver cancer. Conclusion Hospital admissions of individuals with HBV infection are increasing in Spain. While hepatic decompensation events declined following the introduction of potent oral nucleos(t)ide therapy, HBV‐related liver cancer is rising. No benefit of oral antiviral therapies is seen on hepatitis delta.

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Section: Discussionmentioning

confidence: 99%

Impact of potent nucleos(t)ide therapy on hepatitis B hospitalisations in Spain

Ramos-Rincón

Pinargote‐Celorio

Mendoza

et al. 2022

Aliment Pharmacol Ther

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“…The need for lifelong oral nucleos(t)ide therapy represents an additional challenge for the adequate management of chronic hepatitis B patients. In this regard, the advent of long‐acting antiviral formulations may improve the benefit of HBV therapies 21,22 …”

Section: Discussionmentioning

confidence: 99%

Susceptibility to hepatitis B virus infection in adults living in Spain

Soriano

Aguilera

Benito

et al. 2023

Liver International

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Background: A protective hepatitis B virus (HBV) vaccine has been available for four decades. Universal HBV vaccination of infants is recommended by the WHO since the 1990s. Furthermore, HBV immunization is advised for all adults with high-risk behaviours and no seroprotection. However, HBV vaccine coverage remains globally suboptimal. The advent of new more efficacious trivalent HBV vaccines has renewed the interest in HBV vaccination. At present, the extent of current HBV susceptibility in adults remains unknown in Spain.Methods: HBV serological markers were assessed on a large and representative sample of adults in Spain, including blood donors and individuals belonging to high-risk groups. Serum HBsAg, anti-HBc and anti-HBs were tested in specimens collected during the last couple of years.Results: From 13 859 consecutive adults tested at seven cities across the Spanish geography, overall 166 (1.2%) had positive HBsAg. Past HBV infection was recognized in 14% and prior vaccine immunization in 24%. Unexpectedly, 37% of blood donors and 63% of persons belonging to high-risk groups had no serum HBV markers and therefore were potentially HBV susceptible. Conclusion:Roughly 60% of adults living in Spain seem to be HBV susceptible.

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“…The advent of long-acting formulations of tenofovir could facilitate its prescription either as treatment or prevention 92,93 . An additional indirect benefit of using tenofovir chemoprophylaxis would derive from reducing the chances of hepatitis delta acquisition, since this virus requires HBV for transmission 94 .…”

Section: Long-acting Antiviralsmentioning

confidence: 99%

Viral hepatitis in persons living with HIV in the post-COVID era

Soriano¹,

Moreno-Torres²,

Mendoza³

et al. 2024

AIDSRev

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Coinfection with hepatitis viruses A to E is frequent in persons living with HIV (PLWH) and causes significant morbidity and mortality. Oro-fecal transmissible hepatitis A and E mostly produce acute self-limited episodes in poor income regions and in non-vaccinated travelers. In high-income countries, outbreaks of hepatitis A occur in men having sex with men (MSM) and chronic hepatitis E is occasionally reported among PLWH with severe immunodeficiency. Chronic hepatitis B, C, and D are frequent in PLWH in highly endemic regions and globally in persons who inject drugs (PWID) and MSM. Progression to liver cirrhosis and development of hepatocellular carcinoma (HCC) is major clinical complications in coinfected patients. Current estimates for PLWH are of 38 million worldwide. Roughly 12% have chronic viral hepatitis (5 million). Coinfection figures are of 5-10% for HBV (2-4 million), 4% for HCV (1.5 million), and 15% of HBsAg+ for HDV (0.5 million). Oral direct-acting antivirals (DAA) cure almost all treated patients with hepatitis C. However, given that there is no protective HCV immunity, PLWH with high-risk behaviors may experience HCV reinfection episodes. Tenofovir is the drug of choice in PLWH with chronic hepatitis B, given its dual effect on HIV and HBV. Lifelong oral tenofovir suppresses HBV replication and ameliorate liver damage. However, the risk of HCC persists even in the absence of cirrhosis. Finally, HDV causes the worst of viral hepatitis with faster progression to cirrhosis and HCC. An entry inhibitor, bulevirtide, has recently been approved and another drug, lonafarnib, is completing Phase 3 trials. Combination antiviral therapy for hepatitis D could improve dramatically the poor prognosis of HIV-HDV coinfected patients. The resumption of good medical practices in PLWH after the big disruption caused by COVID-19 will reduce the burden of viral hepatitis coinfections. Renewed efforts on HAV and HBV vaccination of susceptible individuals and earlier and wider prescription of antiviral therapy for HBV, HCV, and/or HDV coinfection should be prioritized in PLWH. The benefits of innovative strategies for viral hepatitis, including pre-exposure prophylaxis or use of long-acting antivirals, warrant further consideration in PLWH.

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Ultra-long-acting (XLA) antivirals for chronic viral hepatitis

Cited by 16 publications

References 33 publications

Impact of potent nucleos(t)ide therapy on hepatitis B hospitalisations in Spain

Impact of potent nucleos(t)ide therapy on hepatitis B hospitalisations in Spain

Susceptibility to hepatitis B virus infection in adults living in Spain

Viral hepatitis in persons living with HIV in the post-COVID era

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