Researchers give guidelines to improve hepatitis B treatment

In a recent study, researchers were able to highlight how being infected with both hepatitis B (HBV) and human immunodeficiency virus (HIV) may offer a treatment advantage over infection with only HBV.

In southern Africa, chronic infection with both HBV and HIV is a major problem. Doctors need to understand how these viruses and the medications used to treat them interact with one another, so that they can better diagnose and care for patients. 

Researchers wanted to compare the effects of therapy on patients who had HBV only, with patients who had both HBV and HIV.

For this study the researchers recruited 115 adult patients with chronic hepatitis B infection (CHB). They were recruited from Tygerberg hospital in Cape Town, South Africa. Some patients were infected with HIV (39) and the rest were only infected with HBV. Researchers looked at race, age and sex, and conducted various clinical and laboratory tests. 

They found that patients who only had HBV were less likely to be on any form of antiviral treatment, showing natural symptoms of liver disease (since HBV is a virus that may cause severe liver disease).

The researchers were able to show that individuals with HBV only were at a disadvantage when compared to those with both HIV and HBV, as patients infected with both viruses were likely to be on antiviral HIV treatment, which also offers some benefit in combating HBV infection. 

The results from this study highlight the potential impact of differences between referral, monitoring and treatment options for HBV when compared to HIV and HBV coinfection, which favours those infected with both HIV and HBV. 

The researchers highlighted that we must improve and provide a safer and fairer service for patients infected with HBV only.

One limitation of this study is the small population size that was specific to only one country and their hospital systems. Some, maybe more advanced hospital settings may show an opposite view when compared to what was found in this study. More studies would need to be conducted to truly identify the differences found in this study.

This paper showed the power of collaboration, with researchers working on this project from both South Africa and the United Kingdom. By using a South Africa patient population for this study, it is relevant to a part of Africa’s population. Additionally, the study may help to develop better treatment plans for those suffering with either HBV, HIV or both.

Abstract

Objectives: Prompted by international targets for elimination of hepatitis B virus (HBV), we set out to characterise individuals with HBV monoinfection vs. those coinfected with HBV/HIV, to evaluate the impact of therapy and to guide improvements in clinical care. Methods: We report observational data from a real world cross-sectional cohort of 115 adults with chronic hepatitis B infection (CHB), at a university hospital in Cape Town, South Africa. HIV coinfection was present in 39 (34%) subjects. We recorded cross-sectional demographic, clinical and laboratory data. Results: Compared to those with HIV coinfection, HBV monoinfected adults were less likely to be HBeAg-positive (p=0.01), less likely to have had assessment with elastography (p<0.0001), and less likely to be on antiviral treatment (p<0.0001); they were more likely to have detectable HBV viraemia (p=0.04), and more likely to have features of liver disease including moderate/severe thrombocytopaenia (p=0.007), elevated bilirubin (p=0.004), and elevated APRI score (p=0.02). Three cases of hepatocellular carcinoma all arose in HBV monoinfection. Conclusions: Our data demonstrate that individuals with HBV monoinfection may be disadvantaged compared to those with HIV coinfection, highlighting potential systematic inequities in referral, monitoring and treatment.

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