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La infección por el virus de la hepatitis B (VHB) es una causa significativa de morbimortalidad, sobre todo por la evolución a cirrosis y hepatocarcinoma. La prevalencia y la distribución genotípica del VHB tienen marcadas diferencias geográficas. La infección por el VHB es un proceso muy dinámico, con una fase de inmunotolerancia y alta replicación viral, seguida del aclaramiento del antígeno e de la hepatitis B (HBeAg), no siempre acompañado de remisión de la replicación viral. Es el caso de la hepatitis HBeAg negativa, que representa un grupo relativamente resistente al tratamiento. Los tres fármacos aprobados para el tratamiento del VHB (interferón alfa, lamivudina y adefovir) tienen eficacia limitada. Las recidivas son más frecuentes con lamivudina y adefovir, requiriendo frecuentemente tratamientos prolongados. Mientras la selección de mutaciones de resistencia a lamivudina es frecuente, adefovir tiene una barrera genética alta. La infección por virus de la inmunodeficiencia humana (VIH) tiene una repercusión negativa sobre el VHB, por lo que son necesarias estrategias que atiendan simultáneamente a ambas infecciones.
Palabras clave:
Hepatitis crónica B
Tratamiento anti-VHB
VIH
Infection by the hepatitis B virus (HBV) is a significant cause of morbidity and mortality, mainly due to evolvement to cirrhosis and hepatocellular carcinoma. The prevalence and genotypic distribution of HBV infection has marked geographic differences. HBV infection is a very dynamic process, with a phase of immune tolerance and high viral replication, followed by HBeAg clearance, not always accompanied by complete suppression of HBV replication. The latter situation corresponds to negative HBeAg hepatitis, which represents a group relatively resistent to therapy. The three approved drugs for the treatment of HBV infection (interferon alpha, lamivudine and adefovir) have limited efficacy. Relapses are more common with lamivudine and adefovir, requiring often long-term treatment. While the selection of lamivudine resistance mutations is frequent, adefovir has a high genetic barrier. HIV infection negatively impacts on HBV disease, requiring these coinfected patients strategies aimed to manage both viruses.
Key words:
Chronic hepatitis
Anti-HBV therapy
HIV
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