In patients with comorbid HIV and hepatitis B virus (HBV), combination antiretroviral therapy (cART) containing tenofovir disoproxil fumarate (TDF) increases the likelihood of achieving HBV suppression, according to study results published in Hepatology International.

The results also indicated that patients with hepatitis B e antigen (HBeAg) positivity before treatment initiation were less likely to achieve HBV viral suppression.

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The study included HIV/HBV coinfected patients with available baseline HBV DNA between 2004 and 2016 (n=366). After initiation of cART, determinations of plasma HBV DNA load, HBV serologic markers (hepatitis B surface antigen [HBsAg], anti-HBs, HBeAg, and anti-HBe), and liver function were performed. The researchers explored factors associated with time to undetectable HBV DNA.

The researchers divided the patients into 3 groups:

  • group 1: patients being treated with lamivudine (3TC) as the only anti-HBV therapy (n=73)
  • group 2: patients being treated with TDF-containing cART as initial therapy (n=127)
  • group 3: patients who switched from 3TC-based to TDF-containing cART (n=166) regimen

At year 5, 77.8% of patients in Group 1 achieved HBV suppression compared with 95.7% in Group 2 and 95.7% in Group 3.

After performing multivariable Cox regression analysis, TDF as anti-HBV therapy was significantly associated with HBV suppression (adjusted hazard ratio [aHR] 2.635; 95% CI, 1.720-4.037). However, 3TC alone was not associated with HBV suppression. The results also indicated that HBeAg positivity at baseline was associated with failure to achieve HBV suppression (aHR 0.293; 95% CI, 0.178-0.482).

Loss of HBsAg occurred in 4.1% of patients (n=15), with 1.9% (n=7) seroconversion to anti-HBs positivity. Of 65 HBeAg-positive patients, HBeAg seroconversion occurred in 16.9% (n=11).

“Despite long-term TDF therapy with sustained suppression of HBV replication, seroconversion of HBsAg remained infrequent among HIV/HBV-coinfected patients in a country of hyperendemicity of HBV infection,” the researchers wrote.

Reference

Huang Y, Sun H, Chang S, et al. Long-term virological and serologic responses of chronic hepatitis B virus infection to tenofovir disoproxil fumarate-containing regimens in patients with HIV and hepatitis B coinfection [published online June 8, 2019]. Hepatol Int. doi:10.1007/s12072-019-09953-4