Improvements in parameters of end-stage liver disease in patients with HIV/HBV-related cirrhosis treated with tenofovir.

Abstract

BACKGROUND:

Mortality related to end-stage liver disease is increasing in HIV/hepatitis B virus (HBV)-coinfected patients and effective treatment options are limited. Tenofovir is now widely used in HIV/HBV coinfection and results in significant HBV suppression, in both patients with and patients without lamivudine resistance. The safety and efficacy of tenofovir in HIV/HBV cirrhosis has not been previously described.

METHODS:

Seven cirrhotic HIV/HBV patients treated with tenofovir were identified within the HIV clinic. Parameters of hepatic function, CD4+ T-cell counts, HBV DNA levels and Child-Pugh Class (C-P-C) were determined before and after addition of tenofovir. All patients had prior lamivudine experience with a median baseline HBV DNA of 6.23 x 10(7) copies/ml.

RESULTS:

Four of seven patients were C-P-C -A and hepatitis 'e' antigen (HBeAG) was positive in 4/7 patients. After a median duration of tenofovir of 28 months, all laboratory parameters improved, with significant changes in albumin and prothrombin (PT) (median pre/post-tenofovir: alanine aminotransferase 63/39; bilirubin 26/18; albumin 39/44, P = 0.028; PT 17.5/15, P = 0.018). All three patients with C-P-C -B or -C improved to C-P-C -A, which for one patient enabled removal from the liver transplant waiting list. Three patients lost HBeAG with two anti-HBe seroconversions. Median HBV DNA was suppressed to <35 copies/mi.

CONCLUSIONS:

This study demonstrates that tenofovir can produce HBV viral suppression, HBeAg seroconversion and improvement in markers of hepatic function in HIV/HBV-coinfected patients with cirrhosis. The potential reversal of end-stage liver disease may provide an important survival benefit in this population.

• Authors: Gail V Matthews, David A Cooper, Gregory J Dore
• Journal: Antiviral therapy (Antivir Ther) Vol. 12 Issue 1 Pg. 119-22 ( 2007) ISSN: 1359-6535 [Print] England
• PMID: 17503756 (Publication Type: Journal Article)

Chemical References

• DNA, Viral
• Hepatitis B e Antigens
• Organophosphonates
• Reverse Transcriptase Inhibitors
• Tenofovir
• Adenine

Topics

• Adenine (analogs & derivatives, therapeutic use)
• CD4 Lymphocyte Count
• DNA, Viral (blood)
• Follow-Up Studies
• HIV Infections (complications, drug therapy, immunology)
• Hepatitis B (blood, complications, drug therapy, genetics, immunology)
• Hepatitis B e Antigens (blood)
• Hepatitis B virus (genetics)
• Humans
• Liver Cirrhosis (complications, drug therapy, pathology, virology)
• Liver Failure (drug therapy, pathology, virology)
• Male
• Middle Aged
• Organophosphonates (therapeutic use)
• Reverse Transcriptase Inhibitors (therapeutic use)
• Severity of Illness Index
• Tenofovir
• Time Factors
• Treatment Outcome
• Viral Load