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Dec24
HEPATITIS B TREATMENT : EITHER ALONE OR WITH HIV /AIDS & HCV INFECTION -RECENT ACHIEVEMENTS
HEPATITIS B TREATMENT : EITHER ALONE OR WITH HIV /AIDS & HCV INFECTION -RECENT ACHIEVEMENTS
DR.D.R.NAKIPURIA ,SENIOR GASTRO INTEST SPECIALIST & HIV/AIDS CONSULTANT drnakipuria@gmail.com, 09434143550,09832025O33
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Treatment for chronic hepatitis B virus (HBV) infection has advanced as fast as approval of new drugs has led to higher response rates.

Nucleoside/nucleotide analogs are the mainstay of hepatitis B treatment. FDA-approved options include Baraclude (entecavir), Epivir (lamivudine or 3TC), Hepsera (adefovir dipivoxil), Tyzeka (telbivudine), and Viread (tenofovir disoproxil fumarate). Emtriva (emtricitabine) is also active against HBV, but has not yet been approved for this purpose. These are all pills taken once daily. Conventional interferon and pegylated interferon alfa-2a (Pegasys) are also approved for treating hepatitis B. The more potent formulation, Pegasys, is injected once weekly.

Not everyone with hepatitis B needs treatment, depending on the extent of liver damage and other factors. A complete cure, meaning HBV clearance and development of protective antibodies, is uncommon. But most people can achieve viral load suppression, which lowers their risk of developing liver cirrhosis and liver cancer. Treatment usually lasts for at least one year, and many people stay on nucleoside/nucleotide analogs for several years to maintain viral suppression.

There are three ways to measure hepatitis B treatment response. Virologic response means suppression of viral replication, ideally reaching undetectable HBV DNA viral load in the blood. Biochemical response is normalization of the liver enzyme alanine aminotransferase, or ALT. Serological response refers to clearance of HBV antigens and development of antibodies (seroconversion).

U.S. and European treatment guidelines recommend Baraclude or Viread monotherapy for first-line hepatitis B treatment for HIV-negative people. These drugs offer the best overall response rates and a high barrier to resistance. There are two types of HBV, hepatitis B "e" antigen (HBeAg) negative and positive, the latter being harder to treat. In clinical trials, virologic response rates for Baraclude and Viread were 90% and 93%, respectively, for HBeAg-negative people, and 67% and 76% for HBeAg-positive people. Both drugs are generally safe and well tolerated, though tenofovir can sometimes cause bone loss and kidney impairment. Combining nucleoside/nucleotide analogs does not significantly improve response for hepatitis B treatment-naïve people, but it may be beneficial for people with drug-resistant HBV.

Lamivudine, which is available in a generic formulation, is the least expensive treatment, but drug resistance is common. Pegylated interferon promotes HBeAg seroconversion, and combining interferon with nucleoside/nucleotide analogs improves effectiveness. But interferon can cause difficult side effects, and combining it with Tyzeka can cause peripheral neuropathy.

Viread, Epivir, and Emtriva are active against both HBV and HIV. Guidelines recommend that people with HIV and HBV co-infection should include dually active drugs in their antiretroviral regimen. HIV/HBV co-infection should be managed by clinicians who have experience treating both diseases, since using these medications incorrectly can lead to drug resistance in one or both viruses.if cd4 count is low then first HIV treatment started and later HBV is started and drugs mostly choosen Tenofovir Fumarate with Lamivudine or Emtricitabine with Ritonavir boosted Atazanavir or daruprenavir .But if HBV detected with HIV and whatever CD4 c ount being presentHIV treatment is immedaitely started.With HCV first started HIV and then pegalyated Interferon 2a or 2b started as tackle both HCV and HBV with it Ribavarin added which kill HCV.New DASS drugs like Sobosfuvir,Sime revir ,GS5885 ,Tela previr,Sovaprevir Boceprevir may be also helpful. HBV can be prevented by a three-dose vaccine. This is now included in routine infant vaccinations and is recommended for many adults, including gay men, pregnant women, and people with HIV or hepatitis C.


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