Monitoring the HIV-infected patient with chronic hepatitis B virus infection
- Kenneth E Sherman, MD, PhD
Kenneth E Sherman, MD, PhD
- Professor of Medicine
- University of Cincinnati College of Medicine
- Chloe L Thio, MD
Chloe L Thio, MD
- Professor of Medicine
- Johns Hopkins University
The era of potent antiretroviral therapy has led to declining rates of opportunistic infections and a new focus on other leading causes of morbidity, such as end-stage liver disease secondary to chronic hepatitis B virus (HBV) infection . The treatment and prevention of hepatitis B has taken on great significance in light of the negative impact HIV has on the natural history of chronic hepatitis B infection. Patients with chronic HBV and HIV coinfection should be treated with a regimen that is effective against both HIV and HBV.
However, treatment of HBV in the HIV-infected patient can be complicated by drug-induced hepatotoxicity, immune constitution syndromes, and toxicity related to medications. Furthermore, regardless of whether the patient is treated, surveillance for development of hepatocellular carcinoma is required.
Monitoring of the patient with HIV/HBV coinfection, regardless of whether the patient is taking antiviral therapy, will be discussed here. The epidemiology, clinical manifestations, diagnosis, management, and prevention of HBV infection are discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of hepatitis B in the HIV-infected patient" and "Pretreatment evaluation of chronic hepatitis B virus infection in the HIV-infected patient" and "Treatment of chronic hepatitis B in the HIV-infected patient" and "Prevention of hepatitis B virus infection in the HIV-infected adult".)
PATIENT MONITORING DURING HBV THERAPY
HBV DNA and aminotransferase monitoring — Laboratory monitoring during hepatitis B virus (HBV) therapy includes serial aminotransferases and assessment of viral suppression. We typically monitor HBV DNA and aminotransferases every three months until undetectable for at least two consecutive visits. We then decrease the frequency to every six months.
Studies in patients with HBV alone have demonstrated that normalization of aminotransferases and suppression of HBV DNA (with or without HBeAg seroconversion) are associated with improvements in liver histology and lower rates of cirrhosis, hepatic decompensation, and hepatocellular carcinoma . Studies in coinfection suggest similar benefit .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PATIENT MONITORING DURING HBV THERAPY
- HBV DNA and aminotransferase monitoring
- HBeAg status
- Hepatitis B surface antigen
- SCREENING FOR HEPATOCELLULAR CARCINOMA
- MONITORING IN HIV-INFECTED PATIENTS WITH HBV AND HCV
- ABNORMALITIES OF AMINOTRANSFERASES
- Chronic hepatitis B virus infection
- Immune reconstitution inflammatory syndrome
- Drug induced liver injury
- Emergence of HBV drug resistance
- Infection with other hepatitis viruses
- HBV DRUG RESISTANCE TESTING
- MONITORING FOR DRUG SIDE EFFECTS
- DURATION OF HBV THERAPY
- SUMMARY AND RECOMMENDATIONS