Due
to overlapping routes of transmission, many individuals are coinfected with both
hepatitis B virus (HBV) and HIV.
It is estimated that as many as 10% of HIV positive people also have HBV. But
a recent study suggests that clinicians who provide HIV care may not be doing
enough to diagnose and manage hepatitis B.
As
described in the April 1, 2007 issue of Clinical Infectious Diseases, researchers
at the University of Texas Southwestern Medical Center in Dallas identified 357
individuals who tested positive for both HIV
and hepatitis B surface antigen (HBsAg) between 1999
and 2003. Out of this group, 155 patients who were new to the clinic and initiated
antiretroviral therapy were included in the study. Results
•
HBV viral
load measurements were obtained for only 16% of patients before initiation of
antiretroviral therapy, whereas HIV viral load was determined for 99% of patients
before starting HAART.
•
During
the first year of treatment, patients collectively received a total of 497 HIV
viral load tests (median 3 per patient), compared with a total of 85 HBV DNA measurements
(median < 1 per patient).
•
67%
of coinfected patients did not receive any HBV DNA measurements during the first
year of antiretroviral therapy.
•
The
percentage of patients who received any type of HBV monitoring (HBeAg, HBe antibodies,
HBV viral load) after HAART initiation increased from 7% in 1999 to 52% in 2001.
Conclusion
In
conclusion, the authors wrote, "Health care providers treating patients with
HIV infection during the period 1999-2003 infrequently monitored HBV response
in coinfected patients, but they systematically monitored HIV response after [antiretroviral
therapy] initiation."
They added that, "Improved physician
adherence to guidelines that better delineate HBV treatment and monitoring for
patients with HIV-HBV coinfection is needed." It is important that providers
be aware of the HBV status of patients receiving antiretroviral therapy, since
several drugs are active against both HIV and HBV, and using regimens that include
only one such agent could promote the emergence of drug-resistant HBV.
04/10/07
Reference MK
Jain, CK Opio, CC Osuagwu, and others. Do HIV care providers appropriately manage
hepatitis B in coinfected patients treated with antiretroviral therapy? Clinical
Infectious Diseases 44(7): 996-1000. April 1, 2007.
