La Dra. Karine Lacombe, del St. Antoine Hospital de París, intervendrá hoy en la Mesa Clínico-Epidemiológica para la abordar las controversias actuales de la coinfección VIH/VHB.
What are the main novelties in the field of HIV/HBV coinfection that you will show in your paper
Novelties in the field of HIV-HBV coinfection arise from how they lived together and how they grew apart. Presently the main challenges faced by clinicians who deal with HBV mono-infection are related to the possibility of curing HBV in a near future. Defining new biomarkers that coud help evaluating the efficacy of drugs leading to functional cure is one the top Research priorities. Assessing new modes of action in the therapuetic field are also one of the other priorities. Both challenges need to be addressed in the context of HIV. On the other hand, treatment simplification is a hot topic in the field of HIV and the impact of new HIV drugs on mortality and morbidity in coinfected patients are of concern in this population who grow older. My talk will specifically address those aspects of HIV-HBV coinfection.
The HIV / HCV coinfection is called to disappear soon thanks to the ADAs. What scenario arises with HBV?
We are presently far from talking of HBV elimination in people living with HIV. Although HBV replication is perfectly controled in the vast majority of patients, the persistence of integrated DNA in the hepatocyte nucleus makes the functional cure a rare event in coinfected individuals. Durugs with modes of action that are presently being evaluated in HBV mono-infected patients need to be assessed in the context of HIV, with regards to efficacy but although tolerability and drug-drug interaction. Time should not be lost and clinicians as well as drug manufacturers and R&D actors should rapidly engage in designing trials specifically for HIV-infected patients
Hepatitis has historically been some of the main comorbidities associated with HIV. Have the comorbidities associated with aging HIV population detracted attention to hepatitis?
Aging with a chronic viral hepatitis is definitely a competitive risk with regards to other comorbidities such as cancer or cardio-vascular diseases. Compared to HBV monoinfected patients, coinfected patients tend to be better followed on a clinical ground, with a higher reduction in risk behaviors such as tobacco smoking or alcohol consumption. However, compared to HIV monoinfected patients, the risk of liver cancer increases with age, even in virologically controlled patients. That implies to perform a regular screening for liver complications, which adds on the burden of exams that an aging patient is already committed to.
As with HIV, is it also necessary to reinforce or establish new prevention and early diagnosis strategies for HBV that allow the detection of still unknown cases?
Hepatitis infection has to be considered as a sexually transmitted disease in our environment. Therefore harm reduction strategies that apply to HIV also apply to HBV. However, the huge difference between HIV and HBV is that there is a vaccine against the latter : all individuals at risk of acquiring HIV or HBV should be vaccinated against HBV. HBV screening is part of the initial medical evaluation in a subject with a recently diagnosed HIV infection. Prep is also a good way to protect oneself againt HBV, as drugs used to prevent HIV infection also work against HBV transmission.