Co-infection par les virus des hépatites B et D chez les personnes vivant avec le VIH

In patients living with HIV and co-infected with hepatitis B (HBV), the risk of also being infected with hepatitis Delta virus (HDV) is more than 6 times higher than in people infected with HBV alone, particularly among intravenous drug users, men who have sex with men, and people from highly endemic areas such as Central Africa. The presence of HIV-induced immunosuppression has a deleterious effect on the natural history of HDV: it decreases the probability of spontaneous seroconversion, considerably accelerates the progression of fibrosis towards cirrhosis and hepatocellular carcinoma, and significantly decreases the response to pegylated interferon a. On the other hand, coinfection with HDV does not appear to increase the risk of HIV aggravation and the development of AIDS events. No direct antiviral drugs such as bulevirtide or lonafarnib have been specifically evaluated in the context of HIV. To date, the best prevention of HDV infection remains vaccination against HBV. For highly immunocompromised people living with HIV who do not respond to vaccination, including tenofovir in their antiretroviral treatment can act prophylactically against HBV acquisition.