TY - JOUR
T1 - Patterns and causes of suboptimal response to tenofovir-based therapy in individuals coinfected with HIV and hepatitis B virus
AU - Matthews, Gail V.
AU - Seaberg, Eric C.
AU - Avihingsanon, Anchalee
AU - Bowden, Scott
AU - Dore, Gregory J.
AU - Lewin, Sharon R.
AU - Sasadeusz, Joe
AU - Revill, Peter A.
AU - Littlejohn, Margaret
AU - Hoy, Jennifer F.
AU - Finlayson, Robert
AU - Ruxrungtham, Kiat
AU - Saulynas, Melissa
AU - Locarnini, Stephen
AU - Thio, Chloe L.
N1 - Funding Information:
Financial support. This work was supported by the National Institutes of Health (grant number R56AI60449). K. R. has been awarded Senior Researcher Scholar, Thai Research Fund; the National Research University Project of CHE (HR1161A), Ministry of Education; and the Professional Research Team Strengthening Fund, from the National Science and Technology Development Agency, BIOTEC, Ministry of Science and Technology, Thailand. The MACS is funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute. UO1-AI-35042, UL1-RR025005, UO1-AI-35043, UO1-AI-35039, UO1-AI-35040, UO1-AI-35041.
PY - 2013/5/1
Y1 - 2013/5/1
N2 - Background. Tenofovir (TDF) is effective for treatment of hepatitis B virus (HBV) in human immunodeficiency virus (HIV) infection; however, some individuals have ongoing HBV viremia, the reasons for which are unclear. We determined the patterns and factors associated with detectable HBV DNA in HIV-HBV-coinfected subjects on highly active antiretroviral therapy (HAART).Methods. One hundred sixty-five HIV-HBV-coinfected individuals from the United States, Australia, and Thailand, the majority of whom were on HAART at study entry, were prospectively followed semiannually for a median of 2.8 years. Logistic regression was used to determine factors associated with detectable HBV DNA.Results. Anti-HBV regimens were TDF/emtricitabine (57%), lamivudine or emtricitabine (19%), or TDF monotherapy (13%). During follow-up, HBV DNA was detected at 21% of study visits and was independently associated with hepatitis B e antigen (HBeAg), HAART <2 years, CD4 <200 cells/mm3, detectable HIV RNA, reporting <95% adherence, and anti-HBV regimen. TDF/emtricitabine was less likely to be associated with detectable HBV than other regimens, including TDF monotherapy (odds ratio, 2.79; P =. 02). In subjects on optimal anti-HBV therapy (TDF/emtricitabine) and with undetectable HIV RNA, HBeAg, CD4 <200 mm3, and reporting <95% adherence remained associated with detectable HBV DNA. Three main patterns of HBV viremia were observed: persistent HBV viremia, viral rebound (>1 log from nadir), and viral blips. No TDF resistance was identified.Conclusions. Tenofovir/ emtricitabine was superior to other anti-HBV regimens in long-term HBV suppression. HBV viremia on therapy was identified in 1 of 3 main patterns. Suboptimal adherence was associated with detectable HBV DNA during therapy, even when HIV was undetectable.
AB - Background. Tenofovir (TDF) is effective for treatment of hepatitis B virus (HBV) in human immunodeficiency virus (HIV) infection; however, some individuals have ongoing HBV viremia, the reasons for which are unclear. We determined the patterns and factors associated with detectable HBV DNA in HIV-HBV-coinfected subjects on highly active antiretroviral therapy (HAART).Methods. One hundred sixty-five HIV-HBV-coinfected individuals from the United States, Australia, and Thailand, the majority of whom were on HAART at study entry, were prospectively followed semiannually for a median of 2.8 years. Logistic regression was used to determine factors associated with detectable HBV DNA.Results. Anti-HBV regimens were TDF/emtricitabine (57%), lamivudine or emtricitabine (19%), or TDF monotherapy (13%). During follow-up, HBV DNA was detected at 21% of study visits and was independently associated with hepatitis B e antigen (HBeAg), HAART <2 years, CD4 <200 cells/mm3, detectable HIV RNA, reporting <95% adherence, and anti-HBV regimen. TDF/emtricitabine was less likely to be associated with detectable HBV than other regimens, including TDF monotherapy (odds ratio, 2.79; P =. 02). In subjects on optimal anti-HBV therapy (TDF/emtricitabine) and with undetectable HIV RNA, HBeAg, CD4 <200 mm3, and reporting <95% adherence remained associated with detectable HBV DNA. Three main patterns of HBV viremia were observed: persistent HBV viremia, viral rebound (>1 log from nadir), and viral blips. No TDF resistance was identified.Conclusions. Tenofovir/ emtricitabine was superior to other anti-HBV regimens in long-term HBV suppression. HBV viremia on therapy was identified in 1 of 3 main patterns. Suboptimal adherence was associated with detectable HBV DNA during therapy, even when HIV was undetectable.
KW - HIV
KW - adherence
KW - antiretroviral therapy
KW - hepatitis B
UR - http://www.scopus.com/inward/record.url?scp=84876000229&partnerID=8YFLogxK
U2 - 10.1093/cid/cit002
DO - 10.1093/cid/cit002
M3 - Article
C2 - 23315316
AN - SCOPUS:84876000229
SN - 1058-4838
VL - 56
SP - e87-e94
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 9
ER -