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

Li, Yijia; Xie, Jing; Han, Yang; Wang, Huanling; Zhu, Ting; Wang, Nidan; Lv, Wei; Guo, Fengjin; Qiu, Zhifeng; Li, Yanling; Du, Shanshan; Song, Xiaojing; Thio, Chloe L.; Li, Taisheng

doi:10.1097/qai.0000000000000927

Cited by 21 publications

(25 citation statements)

References 22 publications

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“…Indeed, our data showed that 26.1% of the coinfected patients had a HBV viral load >20,000 UI/mL. This finding is in line with what was found in another study conducted in developing countries, where a significant proportion of HIV/HBV coinfected patients present HBV DNA≥ 20,000 IU/mL [ 44 ].…”

Section: Discussionsupporting

confidence: 92%

“…3TC is a backbone option of first line ART regimen, globally recommended and recognized as well tolerated and active against both HIV and HBV [ 47 ]. Prior studies have shown that coinfected people with lower HBV DNA levels (<20,000 IU/mL) or who are HBeAg-negative, can be considered for 3TC monotherapy, when TDF is not readily available or is contraindicated [ 44 ] Briefly, no genetic mutations related to HBV resistance to 3TC were found in the S Ag nor in RT genes. In contrast to our finding, recent studies conducted in northern Mozambique and in other sub-Saharan countries found mutations associated with primary HBV resistance to 3TC [ 28 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

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HBV infection in untreated HIV-infected adults in Maputo, Mozambique

et al. 2017

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BackgroundHIV/ HBV coinfected patients are at high risk of developing chronic HBV infection, liver cirrhosis and hepatocellular carcinoma. In Mozambique, where HIV prevalence is one of the highest in the world, HIV-infected patients are scarcely characterized in terms of HBV coinfection and 3TC-resistance mutations profile.MethodsTo characterize ART-naïve HIV-infected adults, with and without HBV coinfection, a cross-sectional study was conducted between May and November 2012 in two health centers from Maputo city, Mozambique. Subjects were consecutively enrolled in the study and, then, tested for hepatitis B surface antigen (HBsAg). Moreover, CD4+ T cells count, HBV DNA in plasma, HBV genotyping and 3TC-resistance mutations profile of HBV were assessed in HIV/HBV coinfected patients.ResultsIn total, 518 patients were enrolled in the study. The median age was 33 years old and 66.8% were women. The median CD4+ T cells count was 361 cells/mm3 and 47 (9.1%) were coinfected with HBV. Out of 46 coinfected patients, 24 (55.2%) had HBV DNA ≥ 20 - < 20 000 and 12 (26.1%) had HBV-DNA ≥20 000. APRI > 2.0 was reported in 4.3% of coinfected and 1.7% of monoinfected patients (p = 0.228), while FIB-4 > 3.25 was reported in 4.4% of coinfected and 1.3% of monoinfected patients (p = 0.112). Genotype A was the most frequent, identified in 25/27 (92.6%) patients, whereas genotype E was present in 2/27 (7.4%) patients. No patient had 3TC-resistance mutations.ConclusionsThis study showed that HBV coinfection was prevalent among ART-naïve HIV-infected adults in Mozambique. Overall, these data highlight the importance of screening HBV coinfection as an integrated measure of HIV routine care to improve health conditions and treatment of HIV/HBV coinfected patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

HBV infection in untreated HIV-infected adults in Maputo, Mozambique

et al. 2017

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“…As is known, the emergence of HBV drug‐resistant mutations in HIV/HBV co‐infected patients who are on ART including 3TC and/or TDF is common . At 24 months, a very low prevalence (1.9%) of 3TC resistance was found in this study, compared to Gu L's report which indicated 16.0% of the patients harboured 3TC‐resistant mutants after 96‐week treatment .…”

Section: Discussioncontrasting

confidence: 49%

Long‐term observation on hepatitis B surface antigen seroclearance in therapy experienced HIV/HBV co‐infected Chinese

Yang

Gui

et al. 2019

Journal of Viral Hepatitis

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The aim of this retrospective study was to observe hepatitis B surface antigen (HBsAg) seroclearance and explore predictors of HBsAg loss in HIV/HBV‐co‐infected patients receiving long‐term lamivudine or both tenofovir and lamivudine containing therapies. Quantification of HBsAg, hepatitis B e antigen and HBV DNA before and after initiation of HBV‐active antiretroviral therapy in a total of 268 HIV/HBV‐co‐infected patients started treatment between 2005 and 2017 were performed. Over a median of 65.63 months of follow‐up, 10 (3.7%) were observed HBsAg loss and the quantification of HBsAg in 7 (2.6%) patients were less than 50 IU/mL. With the prolongation of antiretroviral therapy duration time, the rates of HBsAg seroclearance tended to increase gradually, rising from 1.8% (3/163) during 2‐4 years treatment to 29.4% (10/34) after antiretroviral therapy for up to 10 years. Lower baseline qHBsAg and HBV DNA levels and strong 12‐month declines in qHBsAg were significantly associated with HBsAg seroclearance. The event of HBsAg seroclearance is uncommon among Chinese individuals with HIV/HBV co‐infection who have been treated with anti‐HBV containing antiretroviral therapy, and lifelong therapy for HBV is needed for HIV/HBV co‐infected patients. Baseline qHBsAg and HBV DNA levels and qHBsAg decline rate were predictors for HBsAg seroclearance.

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“…Fortunately, virological and immunological responses to ART were not affected by HBV coinfection status among Chinese patients [30]. In terms of treatment, prior to widespread availability of TDF through NFATP, the efficacy of using a regimen that included only one active agent (3TC) for HBV coverage was demonstrated among Chinese patients in a study by Li and colleagues, and 3TC alone could be considered for HBV coverage in HIV/ HBV coinfected patients when baseline HBV DNA levels are lower than 20,000 IU/mL, providing a feasible treatment option in resource-limited settings [31]. The current recommendation is to select a HAART regimen that includes two drugs with anti-HBV activity.…”

Section: Promoting Multidisciplinary Care and Integrating The Hiv/aidmentioning

confidence: 99%

Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges

Cao

Hsieh

2020

Curr HIV/AIDS Rep

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Purpose of Review The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic increases in antiretroviral therapy (ART) coverage among HIV-infected Chinese patients. Despite limitations in the number of available free antiretroviral drugs, the overall mortality associated with HIV/AIDS has dropped from 39.3 per 100 person-years in 2002 to 3.1 in 2014. In this review, we summarize the challenges, responses, and achievements of antiretroviral therapy (ART) in China over the past 20 years. Recent Findings Continuous optimization of the Chinese National Guidelines for HIV/AIDS Diagnosis and Treatment has been guided by data from serial domestic multi-center studies aimed at evaluating efficacy and toxicity of available ART regimens among Chinese patients with HIV, with the goal of maximizing adherence, access, and efficacy. In addition, increasing attention has been focused on the importance of continuity in the HIV care cascade to promote linkage to care, and address the multidisciplinary chronic care needs HIV/AIDS patients on lifelong ART. Summary Great progress has been achieved in the past 20 years in terms of access to and optimization of antiretroviral treatment in China. As the number of patients receiving long-term ART continues to grow, the focus of HIV/AIDS treatment has gradually transitioned from urgent care to the management of non-AIDS-related chronic complications and control of chronic inflammation.

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

Cited by 21 publications

References 22 publications

HBV infection in untreated HIV-infected adults in Maputo, Mozambique

HBV infection in untreated HIV-infected adults in Maputo, Mozambique

Long‐term observation on hepatitis B surface antigen seroclearance in therapy experienced HIV/HBV co‐infected Chinese

Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges

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