Therapy Analysis and Evidenced-Based Treatment Guidelines (Including Review of Antiviral Medications)

摘要

OBJECTIVE: To summarize current treatment options and guidelines for treatment of HBV infection and HIV-HBV co-infection, including a review of the relevant antiviral agents.SUMMARY: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection have caused large global epidemics, which may overlap because they are transmitted by similar routes, including sex and injection drug use. About 30% of individuals with chronic HBV infection develop cirrhosis, and 5% to 10% develop hepatocellular cancer (HCC). In HBV-HIV co-infection, HIV decreases the rate at which hepatitis B "E" antigen (HBeAg) is lost, increases levels of HBV DNA, and increases the progression to cirrhosis, the number of liver-related complications, and mortality. Three classes of oral antiviral agents for HBV are approved in the United States. L-nucleoside analogs include lamivudine, emtricitabine, and telbivu-dine. Acyclic adenine phosphonates are adefovir and tenofovir, which is not yet approved for HBV infection. Entecavir is a guanine nucleoside analog.HBV resistance to antiviral agents arises because of HBV's rapid viral production and the high rate of spontaneous mutations. Anti-HBV therapy is also effective in patients with HIV-HBV co-infection. The decision to treat HBV in a patient with HIV-HBV co-infection depends on whether highly active antiretroviral therapy (HAART) for HIV is indicated, the severity of the liver disease, the likelihood of response, and the potential for adverse events. CONCLUSION: Effective treatment of HBV infection is important to reduce risk of cirrhosis, HCC, and death. Treatment of HBV infection in HIV-infected persons should consider the activity of the antiviral agents used against both viruses.