Infection with hepatitis delta virus (HDV) affects approximately 6–14.5% of patients coinfected with HIV-1 and HBV, showing a more aggressive clinical course compared with an HIV-negative population. There is no universally approved treatment for chronic hepatitis D (CHD) in HIV-infected patients. Antiretroviral therapy (ART) containing tenofovir has been recently associated with HDV suppression. Our aim was to evaluate whether the outcome of CHD in HIV-infected patients can be favourably influenced by ART including reverse transcriptase inhibitors.
Methods
The clinical course of four HBV/HDV/HIV-coinfected patients receiving ART were retrospectively examined.
Results
HDV RNA became undetectable in all patients after a variable period of ART along with the disappearance of hepatitis B surface antigen in two of them, and an increase in CD4+ T-cell count. In all patients, virological changes were associated with improved liver function tests and clinical features.
Conclusions
We suggest that ART regimens including drugs active against HBV could have beneficial effects on the clinical course of CHD in patients with HIV-1 by favouring immunological reconstitution.
References
1.
RizzettoM., CaneseM.G., AricòS.Immunofluorescence detection of new antigen-antibody system (delta/anti-delta) associated to hepatitis B virus in liver and in serum of HBsAg carriers.Gut1977; 18: 997–1003.
FarciP., MandasA., CoianaA.Treatment of chronic hepatitis D with interferon alfa-2a.N Engl J Med1994; 330: 88–94.
6.
NiroG.A., CiancioA., GaetaG.B.Pegylated interferon alpha-2b as monotherapy or in combination with ribavirin in chronic hepatitis delta.Hepatology2006; 44: 713–720.
7.
ErhardtA., GerlichW., StarkeC.Treatment of chronic hepatitis delta with pegylated interferon-alpha-2b.Liver Int2006; 26: 805–810.
8.
WedemeyerH., YurdaydinC., DalekosG.N.Peginterferon plus adefovir versus either drug alone for hepatitis delta.N Engl J Med2011; 364: 322–331.
9.
YurdaydinC., BozkayaH., OnderF.O.Treatment of chronic delta hepatitis with lamivudine vs lamivudine+interferon vs interferon.J Viral Hepat2008; 15: 314–321.
10.
NiroG.A., CiancoA., TillmanH.L.Lamivudine therapy in chronic delta hepatitis: a multicentre randomized-controlled pilot study.Aliment Pharmacol Ther2005; 22: 227–232.
11.
OnderF., YakutM., IdilmanR.Entecavir may be beneficial in a subset of patients with chronic delta hepatitis.Hepatology2009; 50Suppl 4: 735A.
12.
MalletV., Vallet-PichardA., PolS.The impact of human immunodeficiency virus on viral hepatitis.Liver Int2011; 31Suppl 1: 135–139.
SorianoV., GrintD., D'Arminio MonforteA.Hepatitis delta in HIV-infected individuals in Europe.AIDS2011; 25: 1987–1992.
15.
ShengW.H., HungC.C., KaoJ.H.Impact of hepatitis D virus infection on the long-term outcomes of patients with hepatitis B virus and HIV coinfection in the era of highly active antiretroviral therapy: a matched cohort study.Clin Infect Dis2007; 44: 988–995.
16.
Fernández-MonteroJ.V., VispoE., BarreiroP.Hepatitis delta is a major determinant of liver decompensation events and death in HIV-infected patients.Clin Infect Dis2014; 58: 1549–1553.
17.
PuotiM., RossiS., ForleoM.A.Treatment of chronic hepatitis D with interferon alpha-2b in patients with human immunodeficiency virus infection.J Hepatol1998; 29: 45–52.
18.
GozlanJ., LacombeK., GaultE., RaguinG., GirardP.M.Complete cure of HBV-HDV co-infection after 24weeks of combination therapy with pegylated interferon and ribavirin in a patient co-infected with HBV/HCV/HDV/HIV.J Hepatol2009; 50: 432–434.
19.
RosaI., CostesL., GarraitV., ChoustermanM.Efficacy of pegylated interferon alpha-2b for the treatment of chronic delta hepatitis in a patient co-infected with HIV.AIDS2005; 19: 2177–2178.
20.
SheldonJ., RamosB., ToroC.Does treatment of hepatitis B virus (HBV) infection reduce hepatitis delta virus (HDV) replication in HIV-HBV-HDV-coinfected patients?Antivir Ther2008; 13: 97–102.
21.
Martín-CarboneroL., TeixeiraT., PovedaE.Clinical and virological outcomes in HIV-infected patients with chronic hepatitis B on long-term nucleos(t)ide analogues.AIDS2011; 25: 73–79.
22.
SorianoV., VispoE., Sierra-EnguitaR.Efficacy of prolonged tenofovir therapy on hepatitis delta in HIV-infected patients.AIDS2014; 28: 2389–2394.
23.
FarciP., RoskamsT., ChessaL.Long-term benefit of interferon alpha therapy of chronic hepatitis D: regression of advanced hepatic fibrosis A.Gastroenterology2004; 126: 1740–1749.
