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Drugs in development hold promise for patients with HIV and HBV coinfection
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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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