Serology All people with HIV infection should be screened for HBV infection. Hepatitis B surface antigen (HBsAg) is the classic marker indicative of chronic infection. Although the detection of HBsAg is usually sufficiently sensitive to establish the presence of chronic HBV infection in the normal host, individuals may occasionally be negative for HBsAg, but still …
Effect of HIV on HBV disease progression HIV co-infection results in considerable modification of the natural history of HBV infection.7-9 Persistent HBV infection is more common in people with HIV infection, with the prevalence of chronic HBV infection estimated at 25%10 compared with a prevalence of 3-5% in HIV-seronegative men who have sex with men. 11,12 Furthermore, during chronic …
General principles Sustained suppression of serum HBV DNA to below the level of detection by the most sensitive available assay method should be the goal of therapy and, at present, treatment of HBV in HIV- HBV co-infection is life-long. Current Australian and US guidelines recommend the consideration of cART in all people with HIV infection …
There are six currently licensed treatments available for the management of HBV infection. These include interferons, nucleoside reverse transcriptase inhibitors (lamivudine, emtricitabine, entecavir and telbivudine) and nucleotide reverse transcriptase inhibitors (tenofovir, tenofovir alafenamide and adefovir). Interferons In immunocompetent people, interferon-alfa (alfa-IFN) therapy may result in HBeAg seroconversion and induce a clinical remission in 20-40% of …
HBV infection in people with HIV infection may result in significant morbidity and mortality. People with HIV-HBV co-infection have higher rates of chronic HBV infection and accelerated hepatic fibrosis and cirrhosis compared with those with HBV infection who do not have HIV infection. Management of each viral infection is complicated by the presence of the …
Lok AS, McMahon BJ. American Association for the Study of Liver Diseases Practice Guidelines. Chronic Hepatitis B. Hepatology 2007;45:507-39. Chronic Hepatitis B: Update 2009 http://www.aasld.org/sites/default/files/guideline_documents/ChronicHepatitisB2009.pdf Cooley L, Ayres A, Bartholomeusz A, et al. Prevalence and characterization of lamivudine-resistant hepatitis B virus mutations in HIV-HBV co-infected individuals. AIDS 2003;17:1649-57. Perrillo R. Acute flares in chronic hepatitis …
David Iser Gastroenterologist, St Vincent’s Hospital, Melbourne Andrew Chan Hepatology Fellow, Austin Health Chronic Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and an important public health concern in Australia. Around 25% of acute HCV infections will clear spontaneously within 6 months; however, the remaining 75% will progress to chronic …
All people with HIV should be screened for HCV, and all people found to have concurrent HCV should be prioritised for treatment of HCV and be managed by a multidisciplinary team with experience in managing both conditions. HIV-HCV is associated with a reduced HCV clearance rate8 and a higher rate of cirrhosis compared with people …
Screening for HCV should be performed in people who have associated identifiable risk factors. Those with HCV are often asymptomatic, unless they have developed advanced liver disease. A major barrier to HCV elimination is that a substantial proportion of those who have acquired HCV are unaware of their status and not adequately screened and therefore, …
Adequate assessment of liver disease severity should be performed in all people with HCV before prescribing DAA treatment. The patient’s cirrhosis status is a requirement when seeking PBS authority, and adequate assessment of liver disease severity helps determine clinical decisions surrounding: treatment priority; factors that may adversely affect treatment efficacy, and therefore the choice of …