Low Prevalence of Liver Disease but Regional Differences in HBV Treatment Characteristics Mark HIV/HBV Co-Infection in a South African HIV Clinical Trial

Ive, Prudence; Macleod, W. Bentley; Mkumla, Nompumelelo; Orrell, Catherine; Jentsch, Ute; Wallis, Carole L.; Stevens, Wendy; Wood, Robin; Sanne, Ian; Bhattacharya, Debika

doi:10.1371/journal.pone.0074900

Cited by 13 publications

(18 citation statements)

References 22 publications

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“…In this study, the sero-prevalence of HBV was 5.9 % and this finding was similar with studies reported in Tigray and Amhara regions, Ethiopia (6.2 %) [ 18 ] and (5.7 %) [ 14 ] respectively. Furthermore, our finding was also similar with a study conducted in South Africa [ 19 ]. This might be due the similarity in HBV endemicity and clinical characteristic of study participants [ 2 ].…”

Section: Discussionsupporting

confidence: 92%

Sero-prevalence of HBV and associated risk factors among HIV positive individuals attending ART clinic at Mekelle hospital, Tigray, Northern Ethiopia

et al. 2016

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BackgroundBecause of the shared mean of transmission, hepatitis B virus (HBV) is one of an important cause of co-morbidity and mortality in peoples living with HIV/AIDS. Hence, the aim of this study was to determine the sero-prevalence of HBV infection and associated risk factors in HIV/AIDS positive individuals attending ART clinic at Mekelle hospital, Mekelle, Northern Ethiopia.MethodsA cross sectional study was conducted from August to October 2014 in HIV/AIDS positive adult individuals. Socio-demographic data and other explanatory variables were collected from 508 study participants using pre-tested and structured questionnaire-based interviews. Serum hepatitis B surface antigen (HBsAg) was detected using commercially available rapid test and third generation enzyme-linked immunosorbent assay (ELISA). Bivariate and multivariate analysis, using SPSS V.20.0, were performed to assess the variables associated with HBV infection and P value less than 0.05 was considered as statistically significant.ResultsA total of 508 study participants, 305 females and 203 males were included in this study with the mean (+SD) age of 37.8 + 9.6. The sero-prevalence of HBsAg was 5.9 %. Male gender (AOR = 2.6, 95 % CI 1.2–5.7), multiple sexual partners (AOR = 4.2, 95 % CI 1.3–13.1) and CD4 count <200 cells/μl (AOR = 3.5, 95 % CI 1.1–11.2) were significantly associated with HBsAg positivity.ConclusionThe prevalence of HBsAg was similar to the general population. However, HIV/AIDS positive individuals with reduced CD4 count, <200 cells/μl, showed a significant association with HBsAg seropositivity. Therefore, we recommended, all HIV/AIDS positive individuals should be screened for HBsAg during their follow for better treatment outcome and minimize risks of HBV transmission.

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Section: Discussionsupporting

confidence: 92%

Sero-prevalence of HBV and associated risk factors among HIV positive individuals attending ART clinic at Mekelle hospital, Tigray, Northern Ethiopia

et al. 2016

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“…This finding is similar to other developing countries where 30 to 50% had baseline HBV DNA <20,000 IU/ml 6, 15, 18 . It is in these people with HBV DNA < 20,000 IU/ml that our study demonstrates >95% HBV suppression rates for 48 weeks in both the 3TC and the TDF+3TC HIV/HBV co-infected groups.…”

Section: Discussionsupporting

confidence: 89%

Lamivudine Monotherapy-Based cART Is Efficacious for HBV Treatment in HIV/HBV Coinfection When Baseline HBV DNA <20,000 IU/mL

Xie

Han

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Although combination antiretroviral therapy (cART) including tenofovir (TDF)+lamivudine (3TC) or emtricitabine (FTC) is recommended for treatment of HIV/HBV co-infected patients, TDF is unavailable in some resource-limited areas. Some data suggest that 3TC monotherapy-based cART may be effective in patients with low pre-treatment HBV DNA. Methods Prospective study of 151 Chinese HIV/HBV co-infected subjects of whom 60 received 3TC-based cART and 91 received TDF+3TC-based cART. Factors associated with HBV DNA suppression at 24 and 48 weeks, including anti-HBV drugs, baseline HBV DNA, and baseline CD4 cell count, were evaluated overall and stratified by baseline HBV DNA using Poisson regression with a robust error variance. Results Baseline HBV DNA≥20,000 IU/ml was present in 48.3% and 44.0% of subjects in the 3TC and TDF groups, respectively (P=0.60). After 48 weeks of treatment, HBV DNA suppression rates were similar between these two groups (96.8% vs. 98.0% for 3TC and TDF+3TC, P>0.999) in subjects with baseline HBV DNA<20,000 IU/ml; while in those with baseline HBV DNA ≥20,000 IU/ml, TDF+3TC was associated with higher suppression rates (34.5% vs. 72.5% in 3TC and TDF+3TC groups, respectively, P=0.002). In stratified multivariate regression, TDF use (RR 1.98, P=0.010) and baseline HBV DNA (per 1 log increase in IU/ml, RR 0.74, P<0.001) were associated with HBV DNA suppression only when baseline HBV DNA≥20,000IU/ml. Conclusion This study suggests that 3TC monotherapy-based cART is efficacious for HBV treatment through 48 weeks in HIV/HBV co-infection when baseline HBV DNA<20,000IU/ml. Studies with long-term follow-up are warranted to determine if this finding persists.

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“…[9–12] Thus, the long-term efficacy of lamivudine-based ART in resource-limited settings may be different than in resource-rich settings. A Thai study of 11 HBeAg-negative and 19 HBeAg-positive HIV-HBV co-infected subjects taking lamivudine-based ART for up to 5 years found that all the HBeAg-negative subjects maintained suppression (HBV DNA <150 IU/ml) and none developed lamivudine-resistant HBV.…”

Section: Introductionmentioning

confidence: 99%

Comparison of HBV-active HAART regimens in an HIV–HBV multinational cohort

Thio

Smeaton

Hollabaugh

et al. 2015

Aids

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Objectives To explore factors associated with short and long-term HBV DNA suppression in a multinational cohort of HIV-HBV co-infected subjects receiving HBV-active antiretrovirals. Methods 115 HIV-HBV co-infected subjects participating in one of two global ACTG randomized clinical trials of different antiretroviral regimens received either HBV-monotherapy with either lamivudine or emtricitabine (N=56) or HBV-dual therapy with TDF plus lamivudine or emtricitabine (N=59). Associations of pre-treatment characteristics with the primary (HBV DNA <200 IU/ml at 24 weeks) and longitudinal outcomes through 144 weeks were explored using logistic regression. HBV drug-resistance mutations were determined by pol sequencing in those with viral rebound. Results The proportion with HBV DNA<200 IU/ml was 60% (95% CI 50%–69%) at 24 weeks and 79% (95% CI 69%–88%) at 144 weeks. Pre-treatment factors associated with the primary outcome were HBV DNA, CD4 T-cell count, and AST, but only pre-treatment HBV DNA remained associated with long-term suppression (P<0.0001). HBV therapy group was not significantly associated with the primary outcome at 24 weeks; however, longitudinally, a greater proportion in the dual therapy group achieved HBV DNA<200 IU/mL (P=0.007). A higher proportion of hepatitis B e antigen negative subjects (n=57) achieved HBV DNA <200 IU/ml at any point, regardless of therapy group. All 12 subjects with emergence of lamivudine-resistant mutants were in the monotherapy group. Conclusions TDF-based dual HBV-active antiretroviral therapy is preferred to treat HIV-HBV co-infected patients. In resource-limited settings where TDF may not be universally available, lamivudine or emtricitabine HBV-monotherapy is a reasonable option in patients with low HBV replication.

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Low Prevalence of Liver Disease but Regional Differences in HBV Treatment Characteristics Mark HIV/HBV Co-Infection in a South African HIV Clinical Trial

Cited by 13 publications

References 22 publications

Sero-prevalence of HBV and associated risk factors among HIV positive individuals attending ART clinic at Mekelle hospital, Tigray, Northern Ethiopia

Sero-prevalence of HBV and associated risk factors among HIV positive individuals attending ART clinic at Mekelle hospital, Tigray, Northern Ethiopia

Lamivudine Monotherapy-Based cART Is Efficacious for HBV Treatment in HIV/HBV Coinfection When Baseline HBV DNA <20,000 IU/mL

Comparison of HBV-active HAART regimens in an HIV–HBV multinational cohort

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