Hepatitis B virus and HIV coinfection: Results of a survey on treatment practices and recommendations for therapy

Paul J. Gaglio, Richard Sterling, Eric Daniels, Ellen Tedaldi

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background. The management of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection is challenged by the selection of patients for therapy, options for antiviral medications, and inconsistency in published treatment guidelines. Methods. A survey was sent to 161 sites in a multicenter HIV clinical trials group to assess HBV screening, criteria for initiation of therapy, and treatment choices for patients coinfected with HBV and HIV. Results. Of 161 sites, 78 completed the survey (response rate, 48.4%). Of these sites, 98.7% screened for HBV infection, 86% vaccinated HIV-infected patients who were not immune to HBV infection, and 79% made treatment decisions without referral to a hepatologist or gastroenterologist. Treatment recommendations varied; 42% of the sites initiated therapy when patients' levels of alanine aminotransferase and aspartate aminotransferase were elevated and HBV DNA level was >105 copies/mL, whereas 49% of the sites initiated therapy in the presence of any detectable HBV DNA level. Antiviral treatment choices for patients who were not concurrently receiving antiretroviral therapy were lamivudine plus tenofovir, adefovir, or interferon. Patients concurrently receiving antiretroviral therapy received lamivudine plus tenofovir preferentially, followed by tenofovir plus emtricitabine, adefovir, or interferon. Ninety-one percent of the sites screened for hepatocellular carcinoma. Conclusions. The majority of HIV-infected patients were screened and vaccinated for HBV infection and underwent surveillance for hepatocellular carcinoma. Decisions regarding the performance of liver biopsy, threshold to initiate therapy, and criteria to discontinue therapy varied, reflecting inconsistencies in available treatment guidelines. Treatment decisions reflected concerns regarding future drug resistance in patients who are naive to antiretroviral therapy and the emergence of drug resistance in patients receiving antiretroviral therapy.

Original languageEnglish (US)
Pages (from-to)618-623
Number of pages6
JournalClinical Infectious Diseases
Volume45
Issue number5
DOIs
StatePublished - Sep 1 2007
Externally publishedYes

Fingerprint

Coinfection
Hepatitis B virus
HIV
Tenofovir
Therapeutics
Virus Diseases
Surveys and Questionnaires
Lamivudine
Drug Resistance
Interferons
Antiviral Agents
Hepatocellular Carcinoma
Guidelines
DNA
Aspartate Aminotransferases
Alanine Transaminase
Patient Selection

ASJC Scopus subject areas

  • Immunology

Cite this

Hepatitis B virus and HIV coinfection : Results of a survey on treatment practices and recommendations for therapy. / Gaglio, Paul J.; Sterling, Richard; Daniels, Eric; Tedaldi, Ellen.

In: Clinical Infectious Diseases, Vol. 45, No. 5, 01.09.2007, p. 618-623.

Research output: Contribution to journalArticle

Gaglio, Paul J. ; Sterling, Richard ; Daniels, Eric ; Tedaldi, Ellen. / Hepatitis B virus and HIV coinfection : Results of a survey on treatment practices and recommendations for therapy. In: Clinical Infectious Diseases. 2007 ; Vol. 45, No. 5. pp. 618-623.
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