Patients with HIV and hepatitis B (HBV) coinfection who received tenofovir-based antiretroviral therapy (ART) rarely demonstrated a detectable HBV DNA at 8-year follow-up. Treatment with tenofovir was also associated with suboptimal adherence, according to research presented at the 10th IAS Conference on HIV Science, held July 21 to 24, in Mexico City, Mexico.
This prospective longitudinal study was designed to determine the durability of HBV virologic control and of clinical outcomes for patients with HIV/HBV coinfection (N=92) after prolonged tenofovir-based ART. Participants from Thailand (n=52) and Australia (n=41) were followed every 6 months for 2 years, then every 12 months for 8 years, with serum samples collected and clinical and laboratory assessments performed at each study visit. The current analysis compared date from follow-up at 5 years and 8 years. Data were available for 64 (68.2%) participants at year 5, and 50 (54.3%) participants at year 8.
By year 5 follow-up, 98.4% of participants had undetectable HBV DNA (<20 IU/mL). This remained stable at year 8 follow-up, at 97.6%. The only participant with detectable HBV DNA also reported suboptimal adherence. Between follow-up at year 5 and year 8, three participants died; this totals the number of deaths over the full duration of follow-up to 6 individuals (6.5%). Continued reductions in some liver parameters were seen, with significantly lower alanine aminotransferase (P =.046) and lactate dehydrogenase (P =.024) at year 8 compared with year 5.
No significant differences were seen in CD4 and CD8 total cell counts, but a significant difference was observed in the CD4/CD8 ratio at year 8 compared with year 5 (0.79 and 0.93, respectively, P =.047). Although there was a statistically significant decrease in quantitative hepatitis B surface antigen between baseline and year 8 follow-up (P =.017), no additional decrease was seen between year 5 and 8 (15.3% at year 5).
Study investigators concluded that detectable HBV DNA in patients taking tenofovir-based ART for 8 years was rare and associated with suboptimal adherence. Improvements in CD4/CD8 ratio and some liver parameters were also seen, and although there was high hepatitis B surface antigen loss, this plateaued at 15.3% at year 5 of ART.
Audsley J, Littlejohn M, Bowden S, et al. Continued virological benefits but stabilised HBsAg loss after 8 years of tenofovir-inclusive ART regimens in HIV-HBV coinfection. Presented at: The 10th IAS Conference on HIV Science; July-21-24, 2019; Mexico City, MX. Abstract 2434.