HBV Nucleoside Analogs

Question 1

HBV Nucleoside Analogs

Answer 1

Entecavir
Adefovir
Telbivudine

Because HBV is a DNA virus, these drugs can compete for viral enzymes with native viral nucleosides just as they do for RT in HIV

Several are effective for both HIV and HBV

All are easy to take; offer an interferon free regimen that is prolonged but well tolerated

Tenofovir is drug of choice in both infections

Active against HBV and HIV; not primarily used for HIV

Question 2

HBV Nucleoside Analogs MOA

Answer 2

Nucleoside analogs inhibit the action of viral DNA polymerase by taking the place of nucleotides in the elongating strand of viral DNA, leading to early termination of the viral DNA strain

Question 3

HBV Nucleoside Analogs Adverse Effects

Answer 3

Very well tolerated; low incidence of adverse effects

Fatigue and elevations in creatinine phosphokinase possible (latter may be associated with HBV itself)

Lactic acidosis (uncommon)

Question 4

HBV Nucleoside Analogs Important Facts

Answer 4

All are effective against HIV (higher doses required than for HBV); if lower dose is used in coninfected patients, will lead to resistance to NRTIs

HBV patients should be tested for HIV before starting

If drug is used for both infections (like lamivudine or tenofovir), give in the higher HIV dose

Drugs of choice for chronic HBV
Do not cure the infection; can repress it to the point that it doesn’t progress