Factors associated with delayed hepatitis B viral suppression on tenofovir among patients coinfected with HBV-HIV in the CNICS cohort.

Abstract

BACKGROUND:

Despite widespread use in HIV and hepatitis B virus (HBV) infection, the effectiveness of tenofovir (TDF) has not been studied extensively outside of small cohorts of coinfected patients with HBV-HIV. We examined the effect of prior lamivudine (3TC) treatment and other factors on HBV DNA suppression with TDF in a multisite clinical cohort of coinfected patients.

METHODS:

We studied all patients enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems cohort from 1996 to 2011 who had chronic HBV and HIV infection, initiated a TDF-based regimen continued for ≥ 3 months and had on-treatment HBV DNA measurements. We used Kaplan-Meier curves and Cox-proportional hazards to estimate time to suppression (HBV DNA level <200 IU/mL or <1000 copies/mL) by selected covariates.

RESULTS:

Among 397 coinfected patients on TDF, 91% were also on emtricitabine or 3TC concurrently, 92% of those tested were hepatitis B e antigen positive, 196 (49%) had prior 3TC exposure; 192 (48%) achieved HBV DNA suppression over a median of 28 months (interquartile range: 13-71). Median time to HBV DNA suppression was 17 months for those who were 3TC-naive and 50 months for those who were 3TC exposed. After controlling for other factors, prior 3TC exposure, baseline HBV DNA level >10,000 IU/mL, and lower nadir CD4 count were independently associated with decreased likelihood of HBV DNA suppression on TDF.

CONCLUSIONS:

These results emphasize the role of prior 3TC exposure and immune response on delayed HBV suppression on TDF.

• Authors: H Nina Kim, Carla V Rodriguez, Stephen Van Rompaey, Joseph J Eron, Chloe L Thio, Heidi M Crane, Edgar T Overton, Michael S Saag, Jeffrey Martin, Elvin Geng, Michael Mugavero, Benigno Rodriguez, W Christopher Mathews, Stephen Boswell, Richard Moore, Mari M Kitahata, Centers for AIDS Research Network of Integrated Clinical Systems
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 66 Issue 1 Pg. 96-101 (May 01 2014) ISSN: 1944-7884 [Electronic] United States
• PMID: 24500175 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Antiviral Agents
• DNA, Viral
• Organophosphonates
• Tenofovir
• Adenine

Topics

• Adenine (analogs & derivatives, therapeutic use)
• Adult
• Antiviral Agents (therapeutic use)
• DNA, Viral (blood)
• Female
• HIV Infections (complications)
• Hepatitis B virus (isolation & purification)
• Hepatitis B, Chronic (complications, drug therapy)
• Humans
• Male
• Middle Aged
• Organophosphonates (therapeutic use)
• Tenofovir
• Time Factors
• Treatment Outcome
• Viral Load