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1 September 2007

Volume 45, Number 5
Clinical Infectious Diseases 2007;45:618–623
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4505-0015$15.00
DOI: 10.1086/520751
HIV/AIDS MAJOR ARTICLE

Hepatitis B Virus and HIV Coinfection: Results of a Survey on Treatment Practices and Recommendations for Therapy

Paul J. Gaglio,1

Richard Sterling,2

Eric Daniels,3

Ellen Tedaldi,4 and the

Terry Beirn

Community Programs for Clinical Research on AIDS Hepatitis Working Groupa

1Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; 2Divisions of Gastroenterology, Hepatology, and Infectious Diseases, Virginia Commonwealth University School of Medicine, Richmond; 3Social and Scientific Systems, Silver Springs, Maryland; and 4Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania

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.

Received 20 December 2006; accepted 18 February 2007; electronically published 30 July 2007.

  • (See the article by Miailhes et al. on pages 624–32 and the editorial commentary by Tillman on pages 633–6)

Reprints or correspondence: Dr. Paul J Gaglio, Sr., Center for Liver Disease and Transplantation, PH‐14, 622 W. 168th St., New York, NY 10032 ().

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Ellen Kitchell, Mamta K. Jain. (2008) Evaluation and treatment of the patient coinfected with hepatitis B and HIV. Current HIV/AIDS Reports 5:3, 103-111
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David M Iser, Joseph J Sasadeusz. (2008) Current treatment of HIV/hepatitis B virus coinfection. Journal of Gastroenterology and Hepatology 23:5, 699-706
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Mark S. Sulkowski. (2008) Management of Hepatic Complications in HIV‐Infected Persons. The Journal of Infectious Diseases 197:s3, S279-S293
Online publication date: 15-May-2008.
Abstract-Full Text-PDF Version (390 kB)
Hans L. Tillmann. (2007) Editorial Commentary: Screening for and Treating Hepatitis B Virus in Patients with HIV Infection. Clinical Infectious Diseases 45:5, 633-636
Online publication date: 1-Sep-2007.
Citation-Full Text-PDF Version (182 kB)
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