Current therapy for hepatitis C or D or immunodeficiency virus concurrent infection with chronic hepatitis B |
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Authors: | Rong-Nan Chien |
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Institution: | (1) Liver Research Unit, Chang Gung Memorial Hospital and University, Keelung, Taiwan, ROC |
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Abstract: | Concurrent hepatitis C virus (HCV), hepatitis delta virus (HDV), or human immunodeficiency virus (HIV) infection with chronic
hepatitis B virus (HBV) appears to increase the risk of progressive liver disease including liver cirrhosis and hepatocellular
carcinoma. There is a 10% prevalence of HCV infection in chronic HBV or HDV infection. Serological evidence of previous exposure
to HBV is found in more than 80% of HIV-positive patients in the high risk group. Notably, the most recently acquired virus
tends to suppress the pre-existing virus. In chronic HBV infection acquired perinatally or in early childhood, usually HCV
is dominant and may suppress or even displace HBV and HDV. Less frequently, HBV or HDV suppresses HCV. It is generally agreed
that the dominant virus should be identified in order to make appropriate treatment decisions. Studies with standard interferon
(IFN) to treat patients with HCV dominantly dual HBV/HCV infection have showed only limited virological response. But high
dose of IFN has been demonstrated with better response rate. Combined ribavirin with standard or pegylated IFN therapy could
achieve a sustained HCV clearance rate comparable with those infected with HCV alone. On the contrary, patients with HBV dominantly
dual viral infection might indicate more appropriate addition of lamivudine to IFN than ribavirin. Additionally, patients
with concurrent infection of HBV and HDV, IFN seems to be the only effective agent. However, the efficacy of IFN is related
to the dose. High dose of IFN 9 MU tiw (thrice per week)] and longer treatment duration (at least 2 years) have been shown
to achieve adequate virological response. In patients with concurrently infected HBV and HIV, anti-HBV therapy should be considered
for all patients with evidence of liver disease, irrespective of the CD4 cell count. In patients not requiring antiretroviral
therapy, HBV therapy should be preferentially based on IFN, adefovir, or telbivudine. In contrast, in patients with CD4 cell
counts <350 cells/μl or those already on antiretroviral therapy, agents with double anti-HBV and anti-HIV activity are preferred.
At present, the evidence of therapeutic efficacy is not sufficient to make a recommendation in treating patients with dual
HBV/HCV or HBV/HDV or HBV/HIV infection. Further studies of the well-designed, larger scale are needed to elucidate the role
of different regimens or combination in the treatment of dual viral infection. |
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Keywords: | Hepatitis B virus Hepatitis C virus Hepatitis delta virus Human immunodeficiency virus Concurrent infection |
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