Hepatitis: Soriano V

Rockstroh JK, Bhagani S, Benhamou Y, Bruno R, Mauss S, Peters L, Puoti M, Soriano V, Tural C, Anonymous00076. · Department of Medicine I, University of Bonn, Bonn, Germany. · HIV Med. · Pubmed #18257771 No free full text.

Abstract: OBJECTIVES: With the decline in HIV-associated morbidity and mortality following the introduction of highly active antiretroviral therapy (HAART), liver disease has emerged as a major cause of death in HIV/hepatitis B virus (HBV) and HIV/hepatitis C virus (HCV) coinfected persons. Therefore, screening for underlying viral hepatitis coinfection and the provision of management and treatment recommendations for patients with chronic viral hepatitis are of great importance in preventing, as far as possible, the development of liver disease. With the introduction of new agents for the treatment of hepatitis B and increased knowledge of how best to manage hepatitis C, an update of current guidelines for management of HBV and HCV coinfection with HIV is warranted. SUMMARY: Clearly, all HIV-infected patients should be screened for hepatitis A, B and C, taking into account shared pathways of transmission. Patients who are seronegative for hepatitis A and B should be considered for vaccination. In HIV-infected patients with chronic hepatitis B, the first important differentiation is whether HAART is required or not. In the setting of stable HIV infection, with no need for HAART, several treatment options are available, namely treatment with interferon, early initiation of HAART, or selective non-HIV active anti-HBV nucleoside therapy, with the aim of achieving undetectable HBV DNA levels. In most cases, undetectable HBV DNA can only be achieved with combination therapy. With regard to hepatitis C, individualized tailoring of the duration of HCV therapy is advisable, taking into account rapid or delayed virological response. In patients who do not achieve at least a 2 log drop in HCV RNA at week 12, treatment can be terminated because of the low probability of achieving sustained virological response. Overall, with the currently available treatment algorithms, HCV can be eradicated in over 50% of patients. Therefore, HCV therapy should be considered and discussed with the patient if an indication for HCV therapy (elevated liver enzymes, positive HCV RNA and >F1 fibrosis) is present. CONCLUSIONS: Management of underlying hepatitis B and/or C in patients with HIV infection is of great importance in preventing liver disease-associated morbidity and mortality.

Soriano V, Rivas P, Nuñez M. · No affiliation provided · Clin Infect Dis. · Pubmed #18937578 No free full text.

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Soriano V, Puoti M, Garcia-Gascó P, Rockstroh JK, Benhamou Y, Barreiro P, McGovern B. · No affiliation provided · AIDS. · Pubmed #18090386 No free full text.

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Soriano V, Labarga P, Ruiz-Sancho A, Garcia-Samaniego J, Barreiro P. · No affiliation provided · AIDS. · Pubmed #17086063 No free full text.

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Soriano V, Sheldon J, Ramos B, Núñez M. · No affiliation provided · AIDS. · Pubmed #16439880 No free full text.

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Martin-Carbonero L, Soriano V. · No affiliation provided · AIDS. · Pubmed #15802981 No free full text.

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Soriano V, González-Lahoz J. · No affiliation provided · Enferm Infecc Microbiol Clin. · Pubmed #15743572 links to  free full text

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Núñez M, Soriano V. · No affiliation provided · J Hepatol. · Pubmed #15710208 No free full text.

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Núñez M, Soriano V. · No affiliation provided · J Infect Dis. · Pubmed #15592995 No free full text.

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Núñez M, Soriano V. · No affiliation provided · AIDS. · Pubmed #15577630 No free full text.

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Soriano V, Puoti M, Sulkowski M, Mauss S, Cacoub P, Cargnel A, Dieterich D, Hatzakis A, Rockstroh J. · No affiliation provided · AIDS. · Pubmed #15090824 No free full text.

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Soriano V, Martín-Carbonero L, García-Samaniego J. · No affiliation provided · AIDS. · Pubmed #12646800 No free full text.

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Soriano V, García-Samaniego J. · No affiliation provided · HIV Clin Trials. · Pubmed #12407483 links to  free full text

Abstract: Liver biopsy was a common procedure in patients with chronic hepatitis C who planned to begin treatment with interferon. The greater response rates seen with the use of dual combination therapy with interferon plus ribavirin and the almost universal recognition of fibrosis and faster progression to cirrhosis seen in HIV-HCV coinfected patients does not justify the request of a liver biopsy before prescribing anti-HCV therapy in this population, outside clinical trials.

Soriano V, Sulkowski M, Bergin C, Hatzakis A, Cacoub P, Katlama C, Cargnel A, Mauss S, Dieterich D, Moreno S, Ferrari C, Poynard T, Rockstroh J. · No affiliation provided · AIDS. · Pubmed #11919483 No free full text.

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Soriano V, Rodríguez-Rosado R, García-Samaniego J. · No affiliation provided · AIDS. · Pubmed #10203378 No free full text.

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Pérez-Olmeda M, Rodríguez-Rosado R, García-Samaniego J, Soriano V. · No affiliation provided · Rev Clin Esp. · Pubmed #10089769 No free full text.

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Tuma P, Vispo E, Barreiro P, Soriano V. · Servicio de Enfermedades Infecciosas, Hospital Carlos III, Madrid, España. · Enferm Infecc Microbiol Clin. · Pubmed #19195436 links to  free full text

Abstract: Chronic hepatitis C virus (HCV) infection is common in HIV-infected individuals, especially if the route of infection is intravenous (e.g. intravenous drug use or blood transfusion). Prognosis is poorer in patients with HCV and HIV coinfection than in those with HCV monoinfection, mainly due to the immunodepression caused by HIV infection and probably also to a direct effect of HIV on the liver. Moreover, although antiretroviral therapy can cause liver damage, there is little doubt about the net benefits obtained with triple therapy in coinfected individuals, since suppression of HIV replication and immune recovery help to halt liver damage. However, not all antiretroviral agents are equal and those with the lowest hepatotoxicity and best metabolic profile should be used in coinfected patients, since hepatic steatosis accelerates progression of hepatic fibrosis and insulin resistance hampers the success of treatment with interferon and ribavirin. Tenofovir is currently one of the safest nucleos(t)ide analogues, due to its low hepatotoxicity and its lack of negative interference on treatment of HCV infection.

Soriano V, Peters MG, Zeuzem S. · Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain. · Clin Infect Dis. · Pubmed #19123867 No free full text.

Abstract: Chronic hepatitis C virus (HCV) infection remains a global health threat with approximately 175 million carriers worldwide. Currently, treatment consists of pegylated interferon alpha plus ribavirin for 12-72 weeks, depending on HCV genotype, baseline viral load, and initial virological response to therapy. Serious adverse effects and limited sustained virological responses with this therapy warrant the need for novel HCV therapies. Specifically targeted antiviral therapies designed to inhibit the HCV serine protease and the RNA-dependent RNA polymerase have recently entered clinical development. Herein, the main characteristics of these new antiviral agents and the most important challenges arising with their use--namely, toxicities and rapid selection of resistance--are discussed.

Sheldon J, Sarmento E Castro R, Soriano V. · Servicio de Enfermedades Infecciosas, Hospital Carlos III, Madrid, España. · Enferm Infecc Microbiol Clin. · Pubmed #19100231 links to  free full text

Abstract: The development hepatitis B virus (HBV) polymerase inhibitors has revolutionised the treatment of chronic HBV infection. However, the emergence of resistance mutations can compromise their clinical efficacy and it is mandatory to know the mechanisms of these resistances, its clinical implications, strategies for prevention and how to deal with the rescue. Since HBV has a high degree of replication and a high error rate, during their life cycle it will produce a large number of punctual mutations in individuals with active replication. Due to the large size of the HBV genome, all the possible changes may occur daily and should be screened before starting any antiviral therapy. Therefore, in individuals infected with HBV there is a mixture of similar viruses that evolves over time (quasispecies), some of which are carriers of resistance mutations to antivirals, which explains why they can be selected quickly after exposure to drug. Of the five drugs approved in Europe for the treatment of hepatitis B, three of them (lamivudine, adefovir and entecavir) are likely to be affected directly by these mutations, as well as other active drugs, such as telbivudine, tenofovir and the emtricitabine. The characterization of the resistance mutations is helpful for the prevention and the optimization of antiviral therapies.

Hofmann WP, Soriano V, Zeuzem S. · No affiliation provided · Handb Exp Pharmacol. · Pubmed #19048206 No free full text.

Abstract: This chapter reviews the main chemotherapeutic strategies used against human infections caused by agents responsible for the most important chronic viral illnesses, namely hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). There is no doubt that most current knowledge about combination antiviral therapy has been developed in the battle against HIV. The availability of more than 20 antiretroviral drugs has permitted to explore their efficacy when given in combination, an opportunity that unfortunately has only been possible since recent years for chronic hepatitis C and still is in the early stages for chronic hepatitis B. However, new antiviral compounds targeting each of these viruses are developed rapidly and will provide further opportunities to explore the efficacy of combination antiviral therapy. While sufficient suppression of HIV RNA and HBV DNA can only be achieved by long-term administration of potent antiviral drugs, HCV RNA may be completely eradicated from the infected individual after a limited duration of treatment.

Haubrich R, Soriano V, Lafeuillade A. · Division of Infectious Diseases, University of California, Antiviral Research Center, San Diego, California, USA. · HIV Clin Trials. · Pubmed #18977724 No free full text.

Abstract: In May 2008, 800 delegates from 64 countries met at the International Symposium on HIV and Emerging Infectious Diseases in France to discuss a list of hot topics in HIV and hepatitis viruses. This article summarizes the statements obtained from these discussions around a list of 10 of these topics: (a) antiretroviral treatment for naïve patients; (b) use of integrase inhibitors; (c) antiretrovirals in development; (d) management of lipid abnormalities; (e) hepatotoxicity of antiretroviral therapy; (f) management of hepatitis B in HIV patients; (g) management of acute hepatitis C in HIV patients; (h) outcome of HIV-HCV co-infected patients; (i) preexposure prophylaxis in HIV infection; and (j) the long road to a preventive HIV vaccine. For each topic, we reported the main data presented by speakers and summarized the results of the subsequent discussions.

Morello J, Rodríguez-Novoa S, Jiménez-Nácher I, Soriano V. · Pharmacy Unit, Hospital Carlos III, Madrid, Spain. · J Antimicrob Chemother. · Pubmed #18931138 No free full text.

Abstract: Ribavirin in combination with pegylated interferon alpha is the current standard treatment for chronic hepatitis C. Adequate exposure to ribavirin seems crucial for achieving the best virological response. However, anaemia is a frequent, dose-dependent limiting side effect of ribavirin use. Therefore, therapeutic drug monitoring of ribavirin plasma concentrations could be a useful tool for individualizing ribavirin dosing. Herein, we review the relationship between ribavirin plasma concentrations and both virological response and toxicity, in order to define an optimal therapeutic range for ribavirin.

Soriano V, Puoti M, Peters M, Benhamou Y, Sulkowski M, Zoulim F, Mauss S, Rockstroh J. · Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain. · AIDS. · Pubmed #18614862 No free full text.

Abstract: Nearly 10% of the estimated 36 million people having HIV worldwide suffer from chronic hepatitis B virus (HBV) infection. The advent of new antiviral agents against HBV and the recent availability of improved molecular diagnostic tools have revolutioned the management of HIV/HBV coinfected patients. The present study represents an update of the current knowledge about HBV/HIV coinfection and an intent to provide practical advise about how to give the best care to HIV-infected persons with chronic hepatitis B.

Pol S, Soriano V. · Liver Unit, Université Paris Descartes, Hôpital Cochin, Paris, France. · Clin Infect Dis. · Pubmed #18513148 No free full text.

Abstract: The management of chronic hepatitis C virus infection in patients coinfected with the human immunodeficiency virus poses a significant challenge. Treatment is influenced by a number of viral and host characteristics, including hepatitis C virus genotype, baseline viremia, and adherence to medication regimen. Accelerated progression of liver disease, immunodeficiency, and hepatotoxicity of antiretroviral drugs are additional concerns in coinfected patients. According to the results of 5 randomized clinical trials, 27%-55% of coinfected patients who received therapy with pegylated interferon-alpha and ribavirin attained a sustained virologic response. These studies also confirm the importance of early virologic response as a predictor of treatment outcome and reveal the considerable proportion of patients who experience hematologic tolerability issues. Effective management strategies that encompass patient and viral factors are necessary to improve the long-term outlook for coinfected patients.

Soriano V, Vispo E, Bottecchia M, Sheldon J, Tuma P, Garcia-Samaniego J, Barreiro P. · Department of Infectious Diseases, Hospital Carlos III, Calle Sinesio Delgado 10, Madrid 28029, Spain. · Curr HIV/AIDS Rep. · Pubmed #18510894 No free full text.

Abstract: Chronic hepatitis B virus (HBV) infection is recognized in 5% to 10% of persons with HIV. Co-infected individuals show an accelerated course of HBV-associated liver disease with faster progression to cirrhosis. The number of anti-HBV drugs has increased in the past few years, and some agents (eg, lamivudine, emtricitabine, tenofovir) also exert activity against HIV-1. Emergence of drug resistance challenges the long-term benefit of anti-HBV monotherapy. Data derived from studies using new more potent anti-HBV drugs are very promising, and strategies to use these antiretrovirals sequentially or in combination are being developed. Appropriate diagnosis and monitoring of chronic hepatitis B, including the use of noninvasive tools for assessing liver fibrosis, measurement of serum HBV-DNA, and drug-resistance testing, along with wise use of antivirals may convert HBV/HIV co-infection in to a manageable disease. Hopefully, this success will translate into a halt of liver-related complications and death in the co-infected population.