echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Infection > Co-infection with HBV, can HIV blockade be performed?

    Co-infection with HBV, can HIV blockade be performed?

    • Last Update: 2022-06-02
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com

    For Medical Professionals Reading Reference HBV infection is not a contraindication to the use of PEP
    .


    Post-exposure prophylaxis (PEP) is a biomedical intervention that uses antiviral drugs to block the post-exposure transmission of human immunodeficiency virus (HIV), providing an opportunity for emergency blocking for people at high risk of HIV exposure, which is figuratively It is called "taking regret medicine" [1]
    .

     The transmission route of HIV overlaps with hepatitis B virus (HBV) to a certain extent, and it is also very common for HIV-infected patients to co-infect with HBV [2]
    .

    So in clinical practice, for HIV high-risk exposed populations with HBV infection, can PEP be performed, and what matters should be paid special attention to? Physician Zhang Lukun from Shenzhen Third People's Hospital shared a PEP case with us, let's take a look at the new inspiration it brings~ Case review This is a 46-year-old male who had unprotected commercial sex 42 hours later Our hospital consults "regret medicine"
    .

     In the past medical history inquiries, the patient denied the history of hepatitis B and other sexually transmitted diseases, and had never been tested for HIV antibodies
    .

    Physical examination revealed nothing special
    .

     ▌After that, we evaluated the applicability of PEP for the patients, mainly including two dimensions: 1.
    The first is case consultation, that is, the patients who come to seek PEP services are firstly evaluated and analyzed for exposure time and exposure risk: (1) Exposure Time: 42 hours (fortunately, it came in time, no more than 72 hours); (2) Exposure risk: The patient was exposed to a prostitute, but she did not use a condom when she had vaginal sex.
    Although there was no HIV antibody test result for the source of exposure, But the risk is higher and is assessed as high-risk HIV exposure
    .

    2.
    The next step is the evaluation of the laboratory test results: the HIV antibody test of the tested subjects was negative, and the blood routine showed no abnormality
    .

    Hepatitis C antibody, syphilis, genital herpes simplex virus (HSV) IgM/IgG were also negative
    .

     However, inconsistent with the past medical history informed by the patient, the patient's biochemical examination showed a slight increase in transaminases, including ALT 56u/L and AST 50u/L; -HBe(+) and anti-HBc(+) are the manifestations of "Little Sanyang" (in fact, the inspection results shall prevail)
    .

     ▌Then the question is, does co-infection with HBV affect the use of PEP? Is this patient going to lose the opportunity to block after the event? In fact, HBV infection is not a contraindication to PEP use
    .

    Therefore, based on the results of case consultation and laboratory examination evaluation, the patient met the criteria for inclusion in PEP, and was given PEP medication after signing the informed consent form: PEP medication regimen: Bikempinol tablets, 1 tablet/day, for 28 days; follow-up requirements: 2 weeks, 4 weeks, 8 weeks, and 24 weeks after taking the medicine, follow-up visits, and at the same time closely monitor the liver function of the patients, and ask them to review the liver function and HBV DNA 4 weeks after stopping the medicine
    .

    The specific follow-up situation is as follows: Table 1: Treatment follow-up situation of the patients The case doctor introduced Zhang Lukun, deputy chief physician, deputy chief physician and master of medicine, Department of Infection, Shenzhen Third People's Hospital
    .

    Secretary of the AIDS Drug Prevention and Intervention Committee of the Chinese Association for the Prevention and Treatment of STDs and AIDS, a member of the Care and Treatment Working Committee of the Chinese Association for the Prevention and Treatment of STDs and AIDS, the first member of the Infectious Diseases Professional Committee of the Guangdong Preventive Medicine Association, and the secretary of the Shenzhen AIDS Diagnosis and Treatment Quality Control Center , Secretary of the AIDS Medical Center of Shenzhen Third People's Hospital
    .

    Participated in a number of national, provincial and Shenzhen-level projects and published many medical papers
    .

     Case inspiration This case is a typical HIV high-risk post-exposure blockade successful case
    .

    In clinical practice, the clinical manifestations of some HIV acute infections are not typical, so HIV RNA detection before PEP is necessary to help exclude HIV acute infection
    .

    In addition, the inquirer in this case has HBV infection and mild abnormal liver function, but HBV infection is not a contraindication to PEP.
    Therefore, it is necessary to closely monitor the patient's liver function and HBV-related indicators after the PEP course of treatment.
    If active HBV replication occurs Hepatitis manifestations, can be referred to a liver disease specialist to continue anti-HBV treatment
    .

    In view of the high rate of HBV infection in China, and some patients are unaware of HBV infection, it is recommended that this point must be emphasized in the PEP informed consent
    .

    Regarding the effectiveness and safety of the blocking drug, the inquirer did not complain of subjective discomfort during the use of Bikempano, and no obvious abnormalities and fluctuations were found in the laboratory monitoring blood routine and biochemical indicators.
    The drug is safe Good
    .

      Senior Doctor Prof.
    Wang Hui Comments on Comments on Doctors Introduction Prof.
    Wang Hui Director, Chief Physician and Professor of the AIDS Medical Center of the Second Affiliated Hospital of Southern University of Science and Technology (Shenzhen Third People's Hospital) Member of the National Health Commission's AIDS Clinical Expert Group Member of the Chinese STD and AIDS Association AIDS Chairman of the Drug Prevention and Intervention Special Committee Vice Chairman of the HIV and Tuberculosis Professional Committee of the Chinese Association for the Prevention and Treatment of STDs and AIDS It is very important to exclude HIV acute phase infection before PEP
    .

    Although 50%-90% of HIV-infected patients in the acute phase have cold-like symptoms such as fever, fatigue, myalgia, rash, and headache, there are still some infected people who have no or ignore symptoms
    .

    Clinicians should ask the inquirer whether there is a high risk of HIV exposure in the past month, and if there is risky behavior, they should be asked in detail whether they have cold-like symptoms or signs, so as to exclude acute infection as much as possible
    .

    It is necessary to improve HIV RNA testing to assist in the exclusion of acute HIV infection in conditions of treatment
    .

     For special HIV exposure risk groups, the implementation of the PEP strategy requires additional medical measures, including: ● For HBsAg positive patients, not only should they evaluate whether they are suitable for PEP, but also closely monitor liver function and HBV-related indicators before and after PEP ( Especially after stopping PEP medication), refer him to the outpatient department of liver disease if necessary
    .

    ●For female inquirers, you should carefully ask whether she is breastfeeding and carry out pregnancy testing at the same time, because the probability of mother-to-child transmission is greatly increased during acute HIV infection; for female inquirers who are breastfeeding, they should be advised to stop breastfeeding; Women who are already pregnant need to confirm with their family members whether to continue the pregnancy.
    If they continue to be pregnant, they should avoid using drugs that are contraindicated in pregnancy
    .

    ●For other inquirers who have chronic diseases or comorbidities and need to take drugs for a long time, they need to be alert to drug-drug interactions (DDIs)
    .

       The editor has something to say: Although the PEP strategy provides a measure of regret after the fact for people at high risk of HIV exposure, it should not be overly relied upon
    .

    The most effective way to avoid HIV infection is to stay away from high-risk behaviors, and don't think about the chance of regret! References: [1] Yang Xinyu.
    The application and challenges of HIV pre-exposure prophylaxis and post-exposure prophylaxis [J].
    China AIDS and STD.
    2019; 25(4): 425-428.
    [2] Cao Yang, Zhou Minghao, Zhai Xiangjun.
    my country 2021; 42(2): 327-334.
    The information is for medical and scientific reference only, and it is not recommended to use any prescriptions approved in your country Use this product in a way that does not match the information,
    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.