Long-Term Hepatitis B Virus Surface Antigen Decay in HIV-1/Hepatitis B Virus-Coinfected Adults Initiating a Tenofovir-Containing Regimen

Abstract

Hepatitis B virus (HBV) surface antigen (HBsAg) decay was explored in HIV-1-and HBV-coinfected patients beginning antiretroviral (ARV) therapy containing tenofovir disoproxil fumarate (TDF). The mean HBsAg decay was 0.38 log 10 IU/ml/year (95% confidence interval [CI], 0.71 to 0.05) in 18 patients with sustained plasma HIV-1 RNA suppression and 0.15 log 10 IU/ml/year (0.21 to 0.09) in 12 patients experiencing HIV-1 virologic failure due to suboptimal adherence to ARV (P ‫؍‬ 0.17). We estimated that six of these 18 patients will attain HBsAg values below 10 IU/ml after 10 years of treatment. Hepatitis B virus (HBV) suppression maintained by treatment with lamivudine (3TC), emtricitabine (FTC), and tenofovir disoproxil fumarate (TDF) reduces the progression of disease to liver failure and the development of hepatocellular carcinoma in HIV-1-infected patients. In some patients, therapy induces a complete loss of HBV surface antigen (HBsAg), indicating control of chronic HBV infection. HBsAg clearance was observed in 3% of HBV envelope antigen (HBeAg)-positive patients uninfected by HIV-1 after 1 year of treatment with 3TC (6), in 8% of HBeAgpositive patients after 3 years of treatment with TDF (5), and in 5% of HBeAg-negative patients after 5 years of treatment with adefovir (4). We conducted a longitudinal analysis of HBsAg concentration in HIV-1-and HBV-coinfected patients to explore the long-term evolution of HBsAg concentration after initiation of antiretroviral therapy (ART) containing TDF. The impact of imperfect adherence to ART on HBsAg decay was also explored.Ethical approval for this study was given by the local ethics committee (Comité de Protection des Personnes Sud Méditer-ranée IV), under the reference Q2011.12.01. Thirty HIV-1/HBVcoinfected subjects monitored in the Montpellier University Teaching Hospital were tested for HBsAg concentration after providing written informed consent. Patients had chronic hepatitis B infection, defined as detectable serum HBsAg for more than 6 months. TDF was initiated as a part of an ARV therapy regimen containing 3TC or FTC and a nonnucleoside reverse transcriptase inhibitor (11 of 30) or protease inhibitors (19 of 30). A mean (standard deviation [SD]) of 8 (Ϯ4) samples were quantified for HBsAg concentration per individual during a mean (SD) follow-up under ART of 6.5 years (Ϯ3).To address the potential impact of suboptimal adherence to ART on HBsAg clearance, we included in the group with suboptimal compliance with therapy 12 subjects that experienced HIV-1 RNA rebound exceeding 3 months during the follow-up and identified regular missed doses during interviews. Subjects who had detectable HIV-1 plasma RNA loads 9 months after initiation of ART were also included in this group. The other 18 individuals were categorized as being optimally treated. At the time of therapeutic initiation, the mean age was 40 years (Ϯ9); CD4 T cell count was 387/mm 3 (Ϯ100); the median (interquartile range[IQR]) HIV-1 RNA level was 4.48 (3.69 to 5.21) log 10 copies/ml, HBV DNA 5.62 (4.9...

Combining rapid diagnostic tests and dried blood spot assays for point-of-care testing of human immunodeficiency virus, hepatitis B and hepatitis C infections in Burkina Faso, West Africa

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