Tenofovir
Therapy
Appears
to
Be
the
Best
Current
Option
for
Treatment
of
HBV
in
HIV-coinfected
Patients
Until
recently,
treatment
options
for
lamivudine-resistant
HBV
were
limited.
Adefovir
dipivoxil
(ADV)
[Hepsera]
10
mg/d
has
been
shown
to
significantly
decrease
serum
HBV
DNA
and
alanine
aminotransferase
(ALT)
levels
and
to
improve
liver
histology
of
HIV-infected
patients
with
LAM-resistant
HBV
coinfection.
However,
ADV
at
10
mg/d
is
not
active
against
HIV.
Tenofovir
disoproxil
fumarate
(TDF)
has
in
vitro
activity
against
both
HIV
and
HBV.
TDF
(Viread)
is
FDA-approved
for
the
treatment
of
HIV-1
in
both
treatment-experienced
and
treatment-naïve
patients.
Numerous
studies
have
demonstrated
the
use
of
TDF
in
the
treatment
of
HIV
infection.
However,
TDF
activity
against
HBV
in
patients
with
HIV
coinfection
has
not
been
widely
studied.
TDF
anti-HBV
efficacy
in
HIV-coinfected
patients
has
been
reported
in
small
studies
with
short
durations
of
therapy.
The
aim
of
the
present
study,
conducted
at
several
French
medical
centers,
was
to
analyze
TDF
efficacy
and
factors
associated
with
HBV
virological
responses
in
a large,
retrospective,
multicenter
cohort
study
of
HBsAg-positive/HIV-coinfected
patients
who
received
TDF
300
mg/d
as
a part
of
an
antiretroviral
regimen.
Results
of
this
study
appear
in
the
March
2006
issue
of
Hepatology.
Sixty-five
HIV/HBV-coinfected
patients
who
received
TDF
for
at
least
6 months
with
serum
HBV
DNA
levels
above
2.3
log10
copies/mL
at
TDF
initiation
and
who
had
stored
serum
samples
before
and
during
TDF
therapy
were
included.
Serum
HBV
DNA
was
measured
on
stored
samples.
Results
·
The
median
follow-up
period
was
12
months.
·
Serum
hepatitis
B e
antigen
(HBeAg)
was
positive
in
54
patients
(83.1%).
·
Fifty-two
patients
(80.0%)
were
receiving
lamivudine
(LAM)
(150
mg
twice
a day),
and
68.8%
had
documented
LAM
resistance
at
baseline.
·
Among
HBeAg-positive
patients,
the
median
reduction
from
baseline
of
serum
HBV
DNA
was
4.56
log10
copies/mL.
·
In
HBeAg-negative
patients,
serum
HBV
DNA
decline
from
baseline
was
2.53
log10
copies/mL.
·
At
the
end
of
the
study,
HBV
DNA
became
undetectable
in
29.6%
and
81.6%
of
the
HBeAg-positive
and
HBeAg
-negative
patients,
respectively.
·
Serum
HBeAg
became
negative
in
4 patients,
2 of
whom
acquired
serum
hepatitis
B e
antibody.
Based
on
the
results,
the
authors
conclude,
“This
retrospective
analysis
demonstrates
the
efficacy
of
TDF
against
wild-type,
presumed
precore
mutants
and
LAM-resistant
HBV
when
used
as
a part
of
anti-retroviral
therapy
in
HIV-coinfected
patients.”
“However,
prospective
studies
with
TDF
are
needed
to
assess
long-term
antiviral
efficacy,
durability
of
HBV
DNA
suppression,
HBeAg
loss
and
seroconversion
rates,
the
potential
for
emergence
of
HBV
resistance,
and
long-term
safety
when
combined
with
either
LAM
or
emtricitabine
(FTC;
Emtriva)
as
first-line
therapy
in
HIV/HBV-coinfected
patients.”
Commentary
Tenofovir
therapy
appears
to
be
the
best
current
option
for
treatment
of
HBV
in
HIV-coinfected
patients,
based
on
the
weight
of
evidence
from
available
studies.
However,
it
is
not
known
if
TDF
is
best
used
as
monotherapy
or
in
combination
with
lamivudine,
or
emtricitabine
or
entecavir
(Baraclude).
Studies
of
these
potential
combinations
are
anxiously
awaited.
02/24/06
Reference
Yves
Benhamou
and
others.
Anti-hepatitis
B virus
efficacy
of
tenofovir
disoproxil
fumarate
in
HIV-infected
patients.
Hepatology
43(3):
548-555.
March
2006.
