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JAC Advance Access published online on November 8, 2009
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkp414
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review

HIV/hepatitis B virus co-infection: current challenges and new strategies

K. Lacombe1,2,3,*, J. Bottero3, M. Lemoine4,5, A. Boyd1,2 and P. M. Girard1,2,3

1 INSERM UMR-S707, Paris, France 2 UPMC, Pierre and Marie Curie School of Medicine, Paris, France 3 Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Paris, France 4 Hepatology Department, Saint-Antoine Hospital, AP-HP, Paris, France 5 INSERM U938, CDR Saint-Antoine, Paris, France

* Corresponding author. Service de maladies infectieuses, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France. Tel: +33-1-49-28-24-38; Fax: +33-1-49-28-21-49; E-mail: karine.lacombe{at}sat.aphp.fr

Chronic hepatitis B virus (HBV) infection, which affects 7%–10% of HIV-infected patients, is associated with an increased frequency of AIDS-related and non-AIDS-related clinical endpoints, such as end-stage liver diseases including cirrhosis and hepatocellular carcinoma. Broad access to a very efficient antiviral therapy containing nucleos(t)ide analogues with dual activity against HBV and HIV reverse transcriptases has initiated a transition in the paradigm of HBV control in the context of HIV-induced immunosuppression. The control of viral replication is not currently such a problem, but preventing the emergence of HBV polymerase and surface gene mutants after prolonged exposure to nucleos(t)ides and their consequences in terms of HBV vaccine escape are the next long-term challenges. Another challenge is the prevention of end-stage liver disease in an ageing population, in whom non-invasive markers of liver fibrosis, although used more frequently as a substitute for liver biopsy, are not the panacea. Finally, access to prevention, diagnosis, care and treatment of HBV infection remains a major issue in developing countries, including most regions of Africa and Asia, where HBV is endemic and the epidemic of HIV infection is still thriving.

Key Words: immunodeficiency , chronic viral hepatitis , epidemiology , prevention , qualitative systematic review


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