Chronic Hepatitis B and HIV Coinfection: a Continuing Challenge in the Era of Antiretroviral Therapy
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HEPATITIS B (JK LIM, SECTION EDITOR)
Chronic Hepatitis B and HIV Coinfection: a Continuing Challenge in the Era of Antiretroviral Therapy H. Nina Kim 1,2
# The Author(s) 2020
Abstract Purpose of Review The burden of chronic hepatitis B (HBV) remains disproportionately high among people living with HIV (PLWH) despite the advent of HBV vaccination and HBV-active antiretroviral therapy (ART). This review summarizes new insights and evolving issues in HIV-HBV coinfection. Recent Findings HBV-HIV coinfection is still a leading cause of cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality more than a decade after the approval of tenofovir. While tenofovir-based ART has been shown to improve rates of HBV virologic suppression and halt fibrosis progression, the long-term benefits on the prevention of end-stage liver disease or HCC in HIV-HBV coinfection have yet to be convincingly demonstrated in PLWH. Missed opportunities for HBV vaccination persist despite evidence of ongoing risk for HBV infection in this population. Summary Even as we work towards HBV elimination and functional cure, ongoing efforts should focus on optimizing risk stratification as well as uptake of HBV-active antiviral therapy and HBV immunization in this priority population. Keywords Hepatitis B . Human immune deficiency virus (HIV) . Coinfection
Introduction With an estimated 257 million people living with chronic hepatitis B (HBV) infection in 2015, HBV is the leading cause of cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality worldwide [1•]. Mortality from chronic viral hepatitis has surpassed deaths from HIV, tuberculosis, and malaria globally, which has prompted the World Health Organization (WHO) to call for the elimination of chronic hepatitis B and C by 2030 [1•]. The true extent of chronic hepatitis B infection among people living with HIV (PLWH) is not known given gaps in HBV screening and surveillance in many parts of the world. One systematic review estimated a global This article is part of the Topical Collection on Hepatitis B * H. Nina Kim [email protected] 1
Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA 98104, USA
2
Center for AIDS Research, University of Washington, Seattle, WA, USA
prevalence of 7.6% in PLWH, with substantial regional variation and higher (11.8%) prevalence among people who inject drugs [2•]. HIV-HBV coinfection is more common in areas with ongoing perinatal HBV transmission as seen in parts of Asia and Africa [3]. The prevalence of chronic HBV in PLWH far exceeds that of the general population. In contrast to the prevalence of chronic HBV among US households of 0.3%, the prevalence within HIV cohorts in the United States (US) is as high as 8– 11% [4–6]. Overlapping routes of the transmission of HIV and HBV likely account for the disproportionate burden of HBV in PLWH. Susceptible PLWH may also be more likely than those without HIV infection to progress to chronic HBV infection when ex
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