Infectious Disease

HIV is related to decreased control of HBV co-infection

January 10, 2022

3 minutes read

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Chung reports that he has received research grants from AbbVie, BMS, Boehringer Ingelheim, Gilead, GSK, Janssen, Merck, and Roche.

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Novel hepatitis B virus RNA and HBV core-related antigen blood tests demonstrated persistent disease activity despite apparently suppressed virus replication in patients receiving antiviral therapy against HBV and HIV co-infection.

To investigate the relationship between HBV-RNA and HBV core-related antigen (HBcrAg) with classic HBV biomarkers, liver histology and liver staining, the researchers analyzed 95 patients (mean age 50 years) who were co-infected with HBV and HIV. They collected demographic, clinical, serological, and virological data at baseline and every 24 weeks to 48 weeks for up to 192 weeks.

In hepatitis Be antigen positive patients, the study showed a decrease in HBV RNA and HBcrAg as well as HBeAg, hepatitis B surface antigen, HBV DNA and hepatitis B core antigen (HBcAg) in hepatocyte staining (P <.05 for all). The researchers did not see any significant decreases for HBV RNA (P = 0.49) and HBcrAg (P = 0.63) in HBeAg negative patients.

Raymond T. Chung, MD, Head of Hepatology at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School, spoke to Healio about the importance of these findings and how they will affect patient care in the future.

Healio: Why did your team conduct this investigation?

Raymond T. Chung: Chronic HBV infection affects more than a quarter of a billion people worldwide and is a leading cause of cirrhosis, liver cancer and death. In

In HIV-infected individuals, the course of chronic HBV is accelerated despite the emergence of effective suppressive antiviral therapy against both viruses. To date, the most reliable blood markers from HBV DNA assays have provided a picture of the degree of replication of HBV. However, you may not be able to distinguish infections with active transcription and translation of viral proteins from inactive infections, and these can have long-term effects on liver damage.

New blood tests called HBV RNA and HBcrAg have been developed to provide insight into these processes. Our previous work had shown that there is sustained activity of HBV RNA and HBcrAg in HBV / HIV co-infected individuals, which may correlate with increased viral activity in the liver that was not detected by HBV DNA testing.

In this study, we asked how these markers change over time (nearly 4 years) in those patients who continue to receive suppressive, dual active antiviral therapy for both HBV and HIV.

Healio: What is the most important take-home message?

Divided: Despite the high frequency of the suppressed phenotype and long treatment, we observed a sustained decline in markers of HBV transcription / translation in HBeAg positive patients (who generally have higher HBV levels) and a plateau of these markers in HBeAg negative patients Patients (who have lower levels of HBV). This finding is noteworthy in that the purported control reflected by undetectable HBV DNA testing does not reflect the sustained slow or stagnant decline in HBV transcription and translation associated with HIV co-infection.

These results suggest that HIV infection is associated with decreased control of HBV infection and provides a basis that HBV-related liver damage may be more progressive in people with HIV compared to people without HIV.

Healio: How do these results inform management for HBV/HIVco-infected patients in the future?

Divided: The results suggest a potential utility for these new assays in tracking HBV, particularly in HBeAg-positive chronically HBV / HIV co-infected patients who are seen to decrease in these markers over time. They also underline the importance of continued antiviral therapy against HBV in this group of patients, regardless of whether they are HBeAg positive or HBeAg negative. Most importantly, they underline an urgent need for agents that promote the functional healing of HBV in order to eliminate the risk of progressive liver disease in HBV / HIV co-infected individuals.

Healio: What additional research, if any, is needed?

Divided: We need to develop additional classes of therapy that will help us achieve a functional cure for HBV in order to really stop the natural course of liver damage, especially in HBV / HIV co-infected individuals, where progression may persist despite apparent virus suppression. Studies of several new classes of anti-HBV therapies are ongoing.

Healio: What advice would you give to clinicians treating this patient subgroup?

Divided: We must continue antiviral therapy and vigilantly maintain the risk of progressive liver disease in our HBV / HIV co-infected patients as the new assays suggest that despite what appears to be suppressed HBV replication, disease activity is sustained with the available treatment.

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