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Drugs in development hold promise for patients with HIV and HBV coinfection
  NEW YORK (Reuters Health) - Nearly four fifths of patients with HIV infection also have serologic evidence of past or present hepatitis B infection. In these patients, HIV exacerbates liver disease, creating a situation in which the hepatitis virus can behave in an opportunistic manner.
This problem, and therapeutic approaches to it, are reviewed in the December 15th issue of Clinical Infectious Diseases by Dr. Marina Nunez of the Hospital Carlos III in Madrid, Spain, with colleagues there and in Italy.
"The treatment of chronic hepatitis B poses specific problems in the context of HIV infection," the authors write.
"On the one hand, anti-HBV drugs show poorer performance, with lower response rates and faster selection of HBV-resistant strains. On the other hand, nucleoside analogues active against both HBV and HIV...if not used appropriately, can induce the selection of resistance mutations in the HIV genome. Therefore, the management of both infections should be carefully coordinated."
The researchers point out that most patients with both infections become resistant to lamivudine after long-term use. There are no data yet on results with pegylated interferon alpha in coinfected patients, but the new agent tenofovir, a nucleoside analogue reverse-transcriptase inhibitor, has shown "excellent" results in short-term studies.
The newly approved emtricitabine, a nucleoside analogue, has activity against both viruses and is "well tolerated and...potent."
According to the authors, preliminary results with emtricitabine and similar agents "are quite promising and probably will widen the therapeutic armamentarium against hepatitis B in patients with HIV infection."
Clin Infect Dis 2003;37:1678-1685
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