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and Hepatitis.com Coverage of the
XVIII International AIDS Conference (AIDS 2010) July 18 - 23, 2010, Vienna, Austria
Drug Resistance Linked to Faster Hepatitis B Liver Disease Progression in HIV/HBV Coinfected Patients
Irina Magdalena from Dumitru Ovidius University in Constanta, Romania, and colleagues looked at the long-term evolution of liver disease among coinfected patients receiving combination ART.
The prospective observation cohort study included 72 HIV/HBV coinfected participants who did not show signs of liver disease at baseline. This group was unlike most US and European HIV cohorts in that just over half (54%) were men and the median age was only 29 years. The median CD4 cell count was low, at 230 cells/mm3. About two-thirds were hepatitis B "e" antigen (HBeAg) negative; none had hepatitis C or D.
were followed for a period of 5 years on ART, and all were taking combination
regimens containing a ritonavir-boosted
protease inhibitor. Clinical and virological data were collected
every 3-6 months and ultrasound imaging was done annually to monitor
for liver cancer; FibroScan (transient elastometry) was performed during
the last year. All patients with detectable serum HBV DNA viral load
were tested for HBV drug resistance.
Based on these findings, the researchers concluded, "In HIV/HBV coinfected patients treated with HAART, lamivudine resistance is less frequent (25%) than in immunocompetent patients (higher than 60%), but when [it] occurred, [it] was associated with an accelerated course of liver disease, with faster progression to cirrhosis, liver insufficiency and HCC."
"Appropriate monitoring of chronic viral hepatitis B in HIV positive patients include[s] the recognition of lamivudine resistance in every case of detectable HBV DNA level," they recommended.
Ovidius University Constanta, Faculty of Medicine, Constanta, Romania; Clinical Infectious Diseases Hospital, Constanta, Romania.