Managing hepatitis B/HIV co-infected: adding entecavir to truvada (tenofovir disoproxil/emtricitabine) experienced patients.

Abstract

BACKGROUND:

Combination emtricitabine (FTC) or lamivudine (LAM) with tenofovir disoproxil (TDF) is the recommended first-line regime for treatment in chronic hepatitis B virus (HBV)/HIV co-infection. However, in those failing to suppress, few data exist regarding further management. In HBV/HIV co-infection, there are no published data describing outcomes when entecavir (ETV) is then added to TDF-based regimes in patients no longer suppressing their HBV. We report the first series of patients using ETV with truvada-based HAART in HBV/HIV co-infected patients with previous HBV therapy failure, including inadequate suppression.

METHODS:

A prospective observational study.

RESULTS:

Thirteen HIV/HBV co-infected patients (all male, hepatitis B e antigen positive and hepatitis B e antibody negative) were commenced on ETV in addition to background truvada. All patients were previously exposed to LAM or FTC and TDF (median 53 months, range 6−123). Seven patients had LAM monotherapy prior to TDF/LAM or FTC combination; the remaining six patients were exposed to FTC or LAM and TDF combination. Median time of follow-up was 74 weeks (range 16−159) and median HBV decline was 2.53 log(10) IU/ml (range 1.28−7.36). Thirty-eight percent of patients achieved undetectable HBV DNA level by the end of the study and eight of 13 (62%) achieved normal alanine aminotransferase (ALT) levels with median reduction −28 U/l (range −152 to 37). TDF was stopped in one patient because of renal toxicity. ETV was well tolerated with no change of estimated glomerular filtration rate during the study.

CONCLUSION:

Entecavir can be considered in addition to TDF/FTC in HBV/HIV co-infected treatment-experienced patients failing to fully suppress their HBV viral load.

• Authors: Libuše Ratcliffe, Michael B J Beadsworth, Ashley Pennell, Matthew Phillips, Francisco J Vilar
• Journal: AIDS (London, England) (AIDS) Vol. 25 Issue 8 Pg. 1051-6 (May 15 2011) ISSN: 1473-5571 [Electronic] England
• PMID: 21346511 (Publication Type: Journal Article)

Chemical References

• Anti-HIV Agents
• DNA, Viral
• Organophosphonates
• Deoxycytidine
• entecavir
• Guanine
• Tenofovir
• Emtricitabine
• Adenine

Topics

• AIDS-Related Opportunistic Infections (drug therapy, virology)
• Adenine (administration & dosage, analogs & derivatives)
• Adult
• Anti-HIV Agents (administration & dosage)
• DNA, Viral (drug effects)
• Deoxycytidine (administration & dosage, analogs & derivatives)
• Drug Administration Schedule
• Drug Therapy, Combination
• Emtricitabine
• Guanine (administration & dosage, analogs & derivatives)
• HIV Infections (complications, drug therapy, virology)
• Hepatitis B virus (drug effects)
• Hepatitis B, Chronic (complications, drug therapy)
• Humans
• Male
• Middle Aged
• Organophosphonates (administration & dosage)
• Prospective Studies
• Tenofovir
• Treatment Outcome