An update on the treatment options for HBV/HCV coinfection

ABSTRACT

Introduction: Despite the reciprocal inhibition exerted by HBV and HCV genomes, dual HBV/HCV infection is associated with more severe forms of liver disease and warrant effective treatment.

Areas covered: A careful evaluation of disease progression to establish the predominance of one virus over another, concomitant HIV infection and comorbidities is essential to make the best therapy choices. In most virological conditions interferon (IFN)-based treatment has been replaced by a combination of different classes of second generation directly acting antivirals (DAAs), which offer better tolerability and HCV eradication in 95% of cases. Tenofovir or entecavir should be part of treatment for patients with active HBV production, for those coinfected with HIV and for those with cirrhosis.

Expert opinion: DAAs have been successfully used to eradicate HCV infection in recent years, but the high cost may limit their use particularly in developing countries. Entecavir and tenofovir have been demonstrated to be effective for long-term inhibition of HBV replication. Careful monitoring of serum ALT and markers of HBV and HCV replication before and during treatment is essential for an early diagnosis and treatment of virus reactivation.

KEYWORDS:

• HBV/HCV coinfection
• HBV/HCV epidemiology
• HBV/HCV interaction
• HBV/HCV treatment

Article highlights

• Hepatitis B virus (HBV) and hepatitis C virus (HCV) share the pathways of transmission and, consequently, dual HBV/HCV infection is frequently observed in geographical areas where both infections have an intermediate or high endemicity level and in special populations at high risk of acquiring both infections.

• Patients with dual HBV/HCV infection more frequently develop liver cirrhosis and hepatocellular carcinoma than those with a single infection.

• Reciprocal inhibition of HBV and HCV genomes has been demonstrated by in vitro, morphologic and clinical investigations.

• In order to make the best choice of treatment, great attention should be paid to the stage of liver disease, virus predominance and the presence of HIV infection and comorbidities.

• Treatments with Peg-IFN and ribavirin for HCV eradication have been replaced by a combination of two or more directly acting antivirals (DAAs) of different classes. DAA regimens have become the treatment of choice even in HBV/HCV dual infection with HCV predominance since well tolerated and effective in about 95% of cases.

• Tenofovir or entecavir must integrate DAA treatment in patients with both HCV and HBV in a productive phase, in those with cirrhosis and in those coinfected with HIV.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.

Notes on contributors

Evangelista Sagnelli

All authors contributed equally to this work, designed the study, and wrote the manuscript.

Caterina Sagnelli

All authors contributed equally to this work, designed the study, and wrote the manuscript.

Margherita Macera

All authors contributed equally to this work, designed the study, and wrote the manuscript.

Mariantonietta Pisaturo

All authors contributed equally to this work, designed the study, and wrote the manuscript.

Nicola Coppola

All authors contributed equally to this work, designed the study, and wrote the manuscript.