HIV and hepatitis B: News on their clinical management

When people with HIV also have hepatitis B, clinical management can be complicated. Next is an update on optimising diagnostics and therapy.

What you should know about hepatitis B and HIV:

Co-morbidity rates vary by region

People living with HIV also contract hepatitis B at different rates. While the prevalence in Africa and Asia is 7% to 12%, it is lower in Europe and Latin America at 5% to 6%. No matter where in the world, however, hepatitis B is the most common chronic viral hepatitis in the vulnerable HIV population. The most common transmission is from mother to child during birth.

HIV positivity has an influence on hepatitis infection

If there is comorbidity with HIV, there is a faster progression of liver fibrosis. Mortality, both related to the liver and in general, also increases. Whether the hepatitis B virus in turn influences the HIV virus remains questionable.

The treatment of hepatitis B can be directed towards different goals: from virus suppression to complete eradication. If functional cure is the goal, this means achieving virus and surface antigen undetectability and normal Alanine transaminase (ALT) serum levels. Studies suggest that this reduces the risk of hepatocellular carcinoma in patients with hepatitis B compared with suppression of the virus alone.

Hepatitis B therapy in HIV-positive patients

Professional societies worldwide recommend treating hepatitis B in people who are HIV-positive with an ART regimen that also includes TDF or TAF and 3TC or FTC.

In addition, it is important to examine patients regularly with an abdominal ultrasound in order to exclude hepatocellular carcinoma or to detect it early. This is especially true for all those affected who have already developed cirrhosis.

Hepatitis D

The hepatitis D virus requires the hepatitis B virus to reach full pathogenicity. Many people suffering from hepatitis B can therefore also develop hepatitis D. In this case, either a mostly temporally limited and rather benign co-infection or a superinfection can occur, which can then be associated with liver failure and chronification. In most cases, especially in HIV patients, a superinfection occurs.

Hepatitis D infection is also associated with an up to threefold increased risk of HCC and increased mortality in people with HIV. It is assumed that in Spain, for example, 26% of all people who are HIV and hepatitis B positive are also infected with the hepatitis D virus.

Currently, the only therapeutic options are interferon treatment or the newly approved drug Bulevirtide.

Conclusion for medical practice

Co-infection with hepatitis B is not uncommon in people with HIV. In clinical management, practitioners should screen their patients for HBV. Vaccination is recommended if risk factors are present. If adequate vaccination protection is not achieved, ART should always include TDF or TAF. In addition, the presence of hepatitis D, liver fibrosis and HCC should always be clarified.

For more articles, please visit our dedicated AIDS 2022 congress page

Session: Co-infections: what is new? Juan BERENGUER, Hosp General Universitario Gregorio Maranon, Hepatitis B, AIDS 2022, 31.7.2022.