Hep B Treatment Update
Treatment GuideJust DiagnosedSex & DatingAfrican AmericanStigmaAsk the HIV DocPrEP En EspañolNewsVoicesPrint IssueVideoOut 100
CONTACTCAREER OPPORTUNITIESADVERTISE WITH USPRIVACY POLICYPRIVACY PREFERENCESTERMS OF USELEGAL NOTICE
© 2024 Pride Publishing Inc.
All Rights reserved
All Rights reserved
By continuing to use our site, you agree to our Private Policy and Terms of Use.
With the approval of a new drug to treat chronic hepatitis B virus it is a good time to review HIV-HBV coinfection. It is also helpful that recommendations of a panel on HIV-HBV coinfection were published in the February 18 issue of the journal AIDS. More has been said about HIVers coinfected with hepatitis C than with HBV, but worldwide, HBV is more common than HCV and causes more illness and death than HCV coinfection in both developed and developing countries. There are about 400 million HBV carriers in the world, with the highest concentrations in the Far East and sub-Saharan Africa. HBV can be found in about 10% of HIV carriers. This is not surprising since HIV and HBV can be transmitted in the same ways: mother to baby, unsafe sex, injection-drug use, and blood transfusions. HIVers are 10 times more likely to carry HBV than the general population. Typically infection with hepatitis B results in the classic symptoms of liver inflammation: nausea, fatigue, low-grade fever, jaundice, dark urine, and light stools. This can occur anywhere from six weeks to six months after contact. Hepatitis B resolves without treatment in 90% of infections, but in 10% the virus does not disappear. HBV becomes integrated into the genetic material of liver cells much like HIV in resting CD4 cells. These people become chronic carriers. In HIV-negative HBV carriers about 25% to 30% will develop serious complications, such as cirrhosis, liver failure, or liver cancer. As in HCV-HIV coinfection, the risk of complications is higher in HBV carriers with HIV coinfection. HBV-HIV coinfected patients have higher levels of hepatitis virus, higher elevations of liver enzymes, and more liver damage upon completion of a biopsy. But the converse is not true: There is no data so far to indicate that HBV increases HIV disease progression. Fortunately or unfortunately, some cases of hepatitis B are milder, and patients might think they have had only a 'stomach bug' for several days. If so, they might never go to a doctor nor know they have become a carrier. So in populations where HBV is common, such as gay men (10% of gay men carry HBV and slightly less than 10% of injection-drug users do), it is important that everyone get screened. If one is negative, then he or she should be vaccinated. Because HBV is integrated like HIV, the goals of treatment are the same'to suppress the virus to delay or stop disease progression. As with HIV, we follow the HBV viral load as our primary marker of treatment success. The first two drugs used to suppress HBV are well-known in HIV treatment circles. First was lamivudine. The second was adefovir. Adefovir started trials as an anti-HIV medication but was abandoned because of kidney toxicity. However, it was effective against HBV'in a smaller, safer dosage than that used for HIV. Adefovir sister compound tenofovir works similarly against HBV. Likewise, emtricitabine has anti-HBV activity similar to lamivudine. Now there is entecavir (Baraclude), which was FDA-approved on March 29. It is taken once a day and has minimal side effects. Like adefovir, it has no effect on HIV; therefore, in a coinfected patient not yet on anti-HIV medications, either adefovir or entecavir would be the drug of choice'so as to avoid the development of HIV drug resistance possible with other agents. In patients on anti-HIV treatment it is recommended that the combination of tenofovir with either lamivudine or emtricitabine be used when appropriate for HIV. This is because of the development of lamivudine resistance in use for HBV, which occurs at a rate of 20% in the first year and 40% by the second. All this activity is somewhat reminiscent of the early days of combination therapy in HIV. And with more than 15 other compounds under investigation for HBV activity, I think we are seeing the beginning of a new era in HBV treatment. Bowers is board-certified in family practice and is a senior partner with Pacific Oaks Medical Group, one of the nation's largest practices devoted to HIV care.
From our Sponsors
Most Popular
The science behind U=U has been liberating people with HIV for years
June 04 2024 3:31 PM
On Anal Sex Day, crack up with The Bottom's Digest
April 18 2024 10:22 AM
As Pride party season begins, the CDC urges mpox vaccinations
May 16 2024 6:52 PM
Todrick Hall has long supported the communities he comes from
April 17 2024 12:02 PM
Exclusive: We kiki with Q from 'RuPaul's Drag Race'
June 24 2024 11:37 AM
The freedom of disclosure: David Anzuelo's journey through HIV, art, and advocacy
August 02 2024 12:21 PM
The Talk: Thriving with HIV
May 08 2024 10:45 AM
The Talk: What HIV isn’t
May 07 2024 10:48 AM
Plus: Featured Video
Latest Stories
How fitness coach Tyriek Taylor reclaims his power from HIV with self-commitment
September 19 2024 12:00 PM
Out100 Honoree Tony Valenzuela thanks queer and trans communities for support in his HIV journey
September 18 2024 12:00 PM
Kentucky bans conversion therapy for youth as Gov. Andy Beshear signs 'monumental' order
September 18 2024 11:13 AM
Why activist Raif Derrazi thinks his HIV diagnosis is a gift
September 17 2024 12:00 PM
Creator and host Karl Schmid fights HIV stigma with knowledge
September 12 2024 12:03 PM
Study finds use of puberty blockers safe and reversible, countering anti-trans accusations
September 11 2024 1:11 PM
Latinx health tips / Consejos de salud para latinos (in English & en espanol)
September 10 2024 4:29 PM
The Trevor Project receives $5M grant to support LGBTQ+ youth mental health in rural Midwest (exclusive)
September 03 2024 9:30 AM
Introducing 'Health PLUS Wellness': The Latinx Issue!
August 30 2024 3:06 PM
La ciencia detrás de U=U ha estado liberando a las personas con VIH durante años
August 23 2024 2:48 PM
Tratamiento y prevención del VIH por inyección: Todo lo que necesita saber
August 23 2024 2:41 PM
Sr. Gay World quiere asegurarse de que estés bien
August 23 2024 2:30 PM
Eureka is taking a break from competing on 'Drag Race' following 'CVTW' elimination
August 20 2024 12:21 PM
With a new case in Sweden, what is the new mpox outbreak and should you be concerned?
August 15 2024 4:48 PM
From ‘The Real World’ to real life: How Danny Roberts thrives with HIV
July 31 2024 5:23 PM
The July/Aug 'Treatment Guide' issue of Plus is here!
June 26 2024 3:49 PM
Activist and philanthropist Bruce Bastian dies at 76
June 26 2024 1:28 PM