Outcomes in HIV-HBV Coinfected Patients Treated with Drugs Active Against Both
Viruses By
Liz Highleyman Immune
suppression due to HIV infection appears
to accelerate the course of liver disease progression in patients with chronic
hepatitis B virus (HBV) coinfection. As
reported in the September 2006 issue of AIDS Research and Human Retroviruses,
Maria Nunez, MD, and colleagues assessed the outcome of HIV-HBV coinfected patients
treated with antiretroviral regimens that contained drugs that were also active
against HBV. Agents
active against both HIV and HBV include: 
lamivudine (3TC; Epivir), approved for
both indications;
emtricitabine
(FTC; Emtriva), a drug related to lamivudine that is approved for HIV but
not yet for HBV;
adefovir (Hepsera), approved for hepatitis B, but
proved too toxic at higher doses for HIV therapy;
tenofovir DF (Viread) approved for HIV and under
study for HBV.
The
present study included 79 HBV surface antigen (HBsAg) positive individuals with
HIV receiving regular care at an HIV clinic in Madrid; 39 were also HBV "e"
antigen (HBeAg) positive. About one-third (37%) had taken lamivudine as their
only anti-HBV agent, and 58% had taken lamivudine plus tenofovir, either simultaneously
or consecutively. Results
After a median follow-up period of 52 months, HBeAg loss occurred in 28% of patients.
13% experienced HBsAg loss.
By multivariate analysis, the only factors associated with undetectable serum
HBV DNA at the end of follow-up were:
- undetectable plasma HIV RNA (OR
4.58; P = 0.02);
- greater CD4 increases on HAART (OR 1.003; P = 0.03).
Conclusion "Anti-HBV
active HAART makes it possible to achieve HBsAg clearance, anti-HBe seroconversion,
and suppression of HBV replication in a substantial proportion of HBV-HIV coinfected
patients, particularly in those with complete HIV suppression and greater immune
recovery," the authors concluded. "Thus, HBV-HIV coinfected patients
might benefit from an earlier introduction of HAART." 10/17/06 Reference
M
Nunez, B Ramos, B Diaz-Pollan, and others. Virological outcome of chronic hepatitis
B virus infection in HIV-coinfected patients receiving anti-HBV active antiretroviral
therapy. AIDS Res Human Retroviruses 22(9): 842-848. September 2006. | 
