Coinfection

Tenofovir Leads to HBsAg Clearance in 8% of HIV/HBV Coinfected Patients

Treatment with tenofovir (Viread) led to hepatitis B surface antigen (HBsAg) clearance -- considered the closest outcome to a cure -- in 8% of HIV positive patients with chronic hepatitis B virus (HBV) coinfection, and in a subgroup clearance was associated with CD4 T-cell count, Dutch researchers reported in the September 15, 2012, Journal of Infectious Diseases.

People with HIV/HBV coinfection tend to experience more aggressive liver disease progression and may not respond as well to hepatitis B treatment as patients with HBV alone. Some anti-HIV drugs, including tenofovir (also in the Atripla, Complera, and Stribild coformulations), are also active against HBV, and current antiretroviral treatment guidelines recommend that coinfected individuals should include at least 1 dually active agent in their regimen.

Roeland Zoutendijk from Erasmus MC University Medical Center in Rotterdam and colleagues analyzed serum HBsAg levels in a Dutch multicenter cohort of 104 HIV/HBV coinfected patients who were treated with tenofovir disoproxil fumarate as part of combination antiretroviral therapy. Participants had been HBsAg positive for at least 6 months and the median duration of treatment was 57 months.

Results

• Hepatitis B "e" antigen (HBeAg) positive participants experienced an average 2.2 log IU/mL decrease in HBsAg during 6 years of tenofovir treatment.
• HBeAg negative patients, in contrast, saw only a 0.6 log IU/mL decline.
• 5 HBeAg positive participants and 3 HBeAg negative patients -- 8% in both groups -- achieved HBsAg clearance.
• The majority of participants who cleared HBsAg did so within the first year on tenofovir.
• HBsAg decreases at 6 and 12 months were significantly correlated with CD4 T-cell counts in the HBeAg positive group, but not in the HBeAg negative group.
• Among HBeAg negative patients, those who cleared HBsAg had lower baseline HBsAg levels than those who remained HBsAg positive.
• Among HBeAg positive patients, HBsAg decline at month 6 was predictive of achieving HBsAg clearance.

"Receipt of [tenofovir] therapy by HIV/HBV coinfected patients for up to 6 years led to a significant decrease in HBsAg in the HBeAg positive population," the researchers concluded.

"HBsAg kinetics early during treatment were predictive of HBsAg seroclearance and correlated with an increased CD4 cell count, underlining the importance of immune restoration in HBV clearance," they added.  

"Clearance of hepatitis B virus in these coinfected patients could be of vital importance for their long-term prognosis," they wrote.

10/2/12

Reference

R Zoutendijk, HL Zaaijer, T.E.M.S. de Vries-Sluijs, et al. Hepatitis B Surface Antigen Declines and Clearance During Long-Term Tenofovir Therapy in Patients Coinfected With HBV and HIV. Journal of Infectious Diseases 206(6):974-980. September 15, 2012.