Hepatologists
face new challenges as hepatitis
progresses in HIV patients. Since successful antiretroviral
therapies have made HIV a treatable condition, more HIV patients who are also
infected with hepatitis B or C
are experiencing the progression of their liver
disease. In the face of this novel challenge, experts in the field convened
to share information and opinions on the management of such patients. The conference
discussions are summarized in the June 2007 issue of Hepatology.
Because
of shared modes of transmission, HIV and viral hepatitis infections often coexist.
Since therapies have made HIV a manageable condition, hepatologists are seeing
more infected patients with complex
liver issues. To address questions about care for these co-infected patients,
an international forum was convened in Jackson Hole, Wyoming in September 2006.
The meeting brought together laboratory and clinical researchers, drug developers
and government representatives to discuss the state of the field, research needs,
and collaborative possibilities. The conference topics are summarized by Kenneth
Sherman, MD, PhD, of the University of Cincinnati and colleagues in the current
issue of Hepatology (June 2007).
An
estimated 3 to 4 million people are infected with both HIV
and hepatitis B (HBV) while 4 to 5 million people
have HIV and chronic
hepatitis C (HCV). "The natural history of coinfection, particularly
for HCV/HIV in the era of highly active antiretroviral therapies is still a matter
of debate, and is important as it influences intervention strategies," the
authors report. However, recent studies have shown increasing rates of liver disease
and related death among those with HIV.
Conference
attendees discussed immune responses to hepatic disease in patients with HIV as
well as how the viruses interact to result in liver injury. They also considered
how treatment options, including antiretroviral agents, might affect the liver.
In treating
HIV/HCV co-infected patients, studies have shown that pegylated interferon with
ribavirin is better than interferon-only regimens. For patients with HIV/HBV,
combination therapy is routine, though viral mutation and drug resistance remain
troubling issues. A key topic of conversation was the development of new agents
for treating viral hepatitis in patients with HIV. Challenges include the risk
of hepatic injury and low patient tolerance which limits compliance. All agreed
that new agents should be tried.
Until
recently, liver transplantation was not an option for patients with HIV; however,
it is now a possibility. "It is imperative not to wait until the patient
is moribund," the authors report, adding that successful outcomes depend
on the collaboration of surgeons, hepatologists, infectious disease specialists
and pharmacologists.
"In
summary, a number of areas were identified as needing further research,"
they conclude. "A close cooperation between clinicians and researchers is
required to ensure high quality translational research."
Source K
Sherman, M Peters and M Koziel. HIV and Liver Disease Forum: Conference Proceedings.
Hepatology 45(6): 1566-1577. June 2007; (DOI: 10.1002/hep.21722). Hepatology
is published by John Wiley & Sons on behalf of the American Association for
the Study of Liver Diseases (AASLD). The article is also available
online at Wiley Interscience.
