Treatment Options for Immunocompromised Patients with Hepatitis B

Kenneth Sherman, MD, discusses current trends in the treatment of hepatitis B in immunocompromised patients and highlights research exploring treatment options for patients coinfected with HIV.

In a session at ID Week 2018 held this year in San Francisco, California, Kenneth Sherman, MD, Gould Professor of Medicine at the University of Cincinnati College of Medicine, presented a session about the hepatitis B virus vaccine.

In the presentation, Dr. Sherman highlighted some of the current and future challenges associated with the treatment and prevention of hepatitis B virus. Additionally, Dr. Sherman discussed hepatitis B infections in immunocompromised patients and what clinicians should expect to see in the future for hepatitis B treatment.

Following his presentation, Dr. Sherman sat down with Contagion® for an exclusive interview on his presentation and his research.

Contagion®: Can you discuss the increased burden of hepatitis B in immunocompromised patients?

Kenneth Sherman, MD: The increased burden of hepatitis B in immunocompromised patients, which most people as a population group presumes is mainly the HIV infected population, is present at the rate of about 10% compared to under 1% in the general US population.

The reason for that is related to the confluence of risk factors that give people both HIV infection and hepatitis B infection. Hepatitis B is very easily spread through sexual contact particularly among men who have sex with men, and, in addition, is potentially spread through parenteral contact through needles.

What should clinicians know about treating immunocompromised patients with hepatitis B?

Immunocompromised patients with hepatitis B are at risk for increased rates of disease progression, related to the presence of hepatitis B. Those patients have higher levels of ALT which reflects higher levels of inflammation which leads to higher rates of hepatic fibrosis.

Therefore, at any given time in the course of the disease, those patients will end up with more likelihood of having eventually cirrhosis and all of the complications that accompany cirrhosis. Often these may be unrecognized until the patient presents with decompensated liver disease.

In 2015, you published a paper called "Management of the Hepatitis B Virus/HIV-Coinfected Patient." What are the optimal treatment options for patients who are coinfected with hepatitis B and HIV?

Today, current recommendations are that HBV/HIV coinfected patients should be treated with hepatitis B active agent, preferably included in the antiretroviral therapy.

For most patients, that includes either the use of tenofovir or tenofovir alafenamide (TAF), and often, because of the nature of the combination with the antiretroviral therapy, that is also including a drug like emtricitabine FTC.

What areas of research are you currently exploring?

I have a number of areas of research that are interesting, but of late, I have been focusing on ways to modulate hepatic fibrosis in those with HIV infection. Our group recently published data in Clinical Infectious Disease regarding blockade or mutations in the CCR5 receptor and how the presence of either blockade or mutations that affect that receptor is associated withe decreased rates of fibrotic progression.

Ultimately, this opens the door to the question: Should all patients with HIV who are at risk of hepatic fibrosis from any cause be on an agent that includes CCR5 and/or CCR2 blockade?

Disclosures:

K. Sherman, Merck: Grant Investigator and Scientific Advisor, Clinical trial contract, Consulting fee, and Research grant. Innovio: Investigator, Clinical trial contract.