Persistent viremia in human immunodeficiency virus/hepatitis B coinfected patients undergoing long-term tenofovir: Virological and clinical implications
Open Access
- 19 April 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hepatology
- Vol. 60 (2), 497-507
- https://doi.org/10.1002/hep.27182
Abstract
Tenofovir (TDF) is considered the ideal treatment for patients coinfected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV). However, certain coinfected patients exhibit incomplete viral suppression, with persistent, and sometimes transient, bouts of HBV replication. The reasons for this, including clinical effect, are unclear. A total of 111 HIV‐HBV‐infected patients undergoing TDF‐containing antiretroviral therapy were prospectively followed. Serum HBV‐DNA viral load, hepatitis surface (HBsAg) and e antigen (HBeAg) status were obtained at baseline and every 6‐12 months. Amino acid (aa) changes on the polymerase gene were assessed using direct sequencing after nested polymerase chain reaction in patients with persistent viremia (PV). After a median of 74.7 months (interquartile range: 33.4‐94.7), virological response (VR; 2,000 IU/mL) was rare (4 of 111; 3.6%) and was associated with nonadherence. At TDF initiation, patients with stabilized VR had significantly higher nadir CD4+ count, compared to those with transient PV (P = 0.006) or LL‐PV (P = 0.04). No consistent aa changes, other than those associated with lamivudine resistance, were observed in patients with persistent viremia. Importantly, HBeAg loss, HBeAg seroconversion, and HBsAg loss only occurred in patients with stabilized VR. Two patients with stabilized VR developed hepatocellular carcinoma and 2 with LL PV died, 1 of a liver‐related cause. Conclusion: Suboptimal HBV control during TDF treatment has a negative effect on serological outcomes, but not necessarily clinical events. Immunoregulation may provide more insight into this phenomenon. (Hepatology 2014;60:497–507)Funding Information
- Gilead Sciences
- Roche
This publication has 35 references indexed in Scilit:
- High Incidence of Treatment-Induced and Vaccine-Escape Hepatitis B Virus Mutants Among Human Immunodeficiency Virus/Hepatitis B-Infected PatientsHepatology, 2013
- The amino acid substitutions rtP177G and rtF249A in the reverse transcriptase domain of hepatitis B virus polymerase reduce the susceptibility to tenofovirAntiviral Research, 2013
- Kinetics of hepatitis B surface and envelope antigen and prediction of treatment response to tenofovir in antiretroviral-experienced HIV–hepatitis B virus-infected patientsAIDS, 2012
- HIV and viral hepatitis coinfections: advances and challengesGut, 2012
- Changes in Serum Levels of HBV DNA and Alanine Aminotransferase Determine Risk for Hepatocellular CarcinomaGastroenterology, 2011
- Liver Fibrosis Changes in HIV–HBV-Coinfected Patients: Clinical, Biochemical and Histological Effect of Long-Term Tenofovir Disoproxil Fumarate UseAntiviral Therapy, 2010
- No Increase in Hepatitis B Virus (HBV)-Specific CD8+T Cells in Patients with HIV-1-HBV Coinfections following HBV-Active Highly Active Antiretroviral TherapyJournal of Virology, 2010
- Chronic hepatitis B: Update 2009Hepatology, 2009
- The rtA194T polymerase mutation impacts viral replication and susceptibility to tenofovir in hepatitis B e antigen-positive and hepatitis B e antigen-negative hepatitis B virus strainsHepatology, 2008
- Predicting Cirrhosis Risk Based on the Level of Circulating Hepatitis B Viral LoadGastroenterology, 2006