HIV and Hepatitis.com Coverage of the
42nd EASL Conference
April 11 - 15, 2007, Barcelona, Spain
THE EUROPEAN ASSOCIATION FOR THE STUDY OF THE LIVER

HAART Regimens Containing Tenofovir Plus Lamivudine or Emtricitabine Work Best for HIV-HBV Coinfected Patients  

By Liz Highleyman

Liver-related morbidity and mortality are increased in HIV-HBV coinfected individuals compared to those with HBV alone. The optimal antiviral therapy for this population is ill-defined; however, guidelines generally recommend that coinfected patients should include in their antiretroviral regimens drugs that are dually active against both HIV and HBV, i.e., tenofovir (Viread), lamivudine (Epivir; 3TC), or emtricitabine (Emtriva; FTC).

As reported at last month’s 42nd Annual Meeting of the European Association for the Study of the Liver, researchers assessed outcomes in a total of 150 HIV-HBV coinfected individuals drawn from the American MACS cohort and 2 HIV clinics in Australia. Patients were followed every 6 months for 3 years, including HBV viral load testing.

Baseline data were available for 120 patients. In the American and Australian cohorts combined, the mean age was 47 years, 98% were male, 88% were men who have sex with men, and 13% were injection drug users; a higher proportion in the American study were of African descent.

The mean duration of HIV infection was 12 years, with a mean nadir CD4 cell count of 179 cells/mm3. At baseline, the mean CD4 count was 442 cells/mm3, 84% were on HAART (mean duration 6.5 years), and 31% had a prior AIDS diagnosis. In terms of HBV status, 47% were HBeAg positive, 49% had undetectable HBV DNA (< 20 IU/mL), and 16% had HBV DNA > 6 log IU/mL.

At baseline, 46% of patients were on antiretroviral regimens that included tenofovir plus either lamivudine or emtricitabine; 28% were taking lamivudine or emtricitabine; 9% were taking tenofovir; and 16% were taking no drugs with anti-HBV activity.

Results

  • Overall, HBV DNA suppression was associated with HAART use (P = 0.02).

  • HAART that included the combination of tenofovir plus lamivudine or emtricitabine was associated with the lowest HBV DNA levels (P = 0.002).

  • The proportions of patients achieving HBV DNA levels < 1000 IU/mL were as follows:
    • 85% of those receiving tenofovir plus lamivudine or emtricitabine;
    • 67% of those receiving lamivudine or emtricitabine as the sole anti-HBV agent;
    • 60% of those receiving tenofovir as the sole anti-HBV agent;
    • 44% of those receiving no anti-HBV agents.

Conclusion

“Data from this large cohort of HIV-HBV coinfected persons demonstrate that the majority (71%) have HBV DNA < 1000 IU/mL,” the investigators concluded. “Preliminary data suggest that combination [therapy] with tenofovir + [lamivudine or emtricitabine] may be most effective at suppressing HBV replication.”

National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW, Australia; VIDRL, Melbourne, VIC, Australia; VIDS, Melbourne, VIC, Australia; The Alfred Hospital, Melbourne, VIC, Australia; John Hopkins University, Baltimore, MD.

05/01/07

Reference
GV Matthews, E Seaberg, GJ Dore, and others. Combination of HBV-active antiretroviral therapy influences HBV virological suppression in an international cohort of 120 HIV/HBV coinfected individuals. 42nd Annual Meeting of the European Association for the Study of the Liver. April 11-15, 2007. Barcelona, Spain.

 

 

 





























HOME