Good
Response to Hepatitis B Treatment is Associated Sustained Response to Antiretroviral
Therapy in HIV-HBV Coinfected Patients
Due
to overlapping transmission routes, many people with HIV also have evidence of
past or present hepatitis B virus (HBV) infection. However, little is known about
the natural history of chronic hepatitis B and
its treatment in HIV-HBV coinfected individuals,
nor about the effects of antiretroviral
therapy in this population.
As reported in the September 1, 2007 issue
of Clinical Infectious Diseases, French researchers retrospectively analyzed
data from 92 HIV-HBV coinfected patients collected before and after HAART and
lamivudine (3TC, Epivir) treatment.
The investigators aimed to determine the impact of treatment on chronic hepatitis
B and factors associated with hepatitis B "e" antigen (HBeAg) or hepatitis
B surface antigen (HBsAg) seroconversion.
Lamivudine is active against
both HIV and HBV, and is approved for the treatment of both diseases. Two other
approved anti-HIV drugs, emtricitabine
(Emtriva) and tenofovir (Viread),
are also active against hepatitis B, but not yet approved for this indication.
Two additional approved anti-HBV drugs, adefovir (Hepsera) and entecavir (Baraclude),
have low-level activity against HIV at standard doses.
Results •
During the follow-up period, 82 patients received antiretroviral therapy, 79 of
whom received combination HAART.
•
76 patients received
lamivudine, 28 of whom (36.8%) developed lamivudine resistance mutations.
•
While receiving antiretroviral
therapy, 10 of 59 HBeAg positive patients (17%) developed antibodies to HBeAg,
3 of 10 (30%) cleared HBsAg, and 2 of 3 (66%) developed antibodies to HBsAg.
•
2 of 23 initially HBeAg
negative patients (9%) cleared HBsAg and developed antibodies to HBsAg.
•
Patients who responded
to anti-HBV therapy with HBeAg and/or HBsAg seroconversion combined with an undetectable
HBV DNA level were more likely to achieve sustained response to anti-HIV treatment
(P = 0.001).
•
This occurred despite
the fact that these patients had a shorter average duration of antiretroviral
therapy and more severe HIV disease (higher CDC stage).
•
For patients with elevated
baseline alanine aminotransferase (ALT) levels, response to anti-HBV therapy correlated
with a larger CD4 cell increase while receiving HAART.
Conclusion
In
conclusion, the authors wrote, "In HIV-HBV coinfected patients, HBV response
correlated with a sustained HIV response to antiretroviral therapy, usually HAART
including lamivudine."
In an editorial accompanying the report, Hans
Tillmann, MD, from the University of Leipzig in Germany noted that the study yielded
some unexpected results, among them that a shorter course of antiretroviral therapy
and lower CD4 cell count were associated with a higher likelihood of HBeAg and/or
HBsAg seroconversion Given
that HBV infection B is preventable with a vaccine -- which has been shown to
be effective in people with HIV -- Tillman emphasized the need for better prevention
and screening efforts rather than waiting to treat HIV positive people until after
they develop chronic hepatitis B. 09/28/07 References
P
Miailhes, MA Trabaud, P Pradat, and others. Impact of highly active antiretroviral
therapy (HAART) on the natural history of hepatitis B virus (HBV) and HIV coinfection:
relationship between prolonged efficacy of HAART and HBV surface and early antigen
seroconversion. Clinical Infectious Diseases 45(5): 624-632. September
1, 2007.
HL Tillman. Screening for and treating hepatitis B virus in patients
with HIV infection. Clinical Infectious Diseases 45(5): 633-636. September
1, 2007.
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