Multiple risk factors for persistent HBV viraemia in an adult receiving nucleos/tide analogue therapy.
Sheila F LumleyMaeve BarlowKhadija Said MohammedEmily MartynElizabeth WaddiloveMarion DelphinDaisy JenningsHaiting ChaiAgnes KemperJoy KoAzim AnsariDouglas MacdonaldIndrajit GhoshSamreen IjazStuart FlanaganPhilippa Clare MatthewsPublished in: Sexually transmitted infections (2024)
Diagnosing and treating chronic hepatitis B virus (HBV) infection are key interventions to support progress towards elimination of viral hepatitis by 2030. Although nucleos/tide analogue (NA) therapy is typically highly effective, challenges remain for viral load (VL) suppression, including medication access, incomplete adherence and drug resistance. We present a case of a long-term HBV and HIV coinfected adult prescribed with sequential NA therapy regimens, with episodes of breakthrough viraemia. Multiple factors contribute to virological breakthrough, including exposure to old NA agents, initial high HBV VL, therapy interruptions, intercurrent illnesses and potential contribution from resistance mutations. The case underscores the importance of individualised treatment approaches and adherence support in achieving HBV suppression. Furthermore, it emphasises the need for improved clinical pathways addressing education, support and access to care, particularly for marginalised populations. Comprehensive data collection inclusive of under-represented individuals is crucial for maintaining retention in the care cascade and informing effective interventions.
Keyphrases
- hepatitis b virus
- liver failure
- healthcare
- palliative care
- physical activity
- quality improvement
- hiv infected
- antiretroviral therapy
- stem cells
- human immunodeficiency virus
- sars cov
- type diabetes
- hiv positive
- big data
- metabolic syndrome
- hepatitis c virus
- hiv aids
- men who have sex with men
- adverse drug
- electronic health record
- combination therapy
- affordable care act
- chronic pain