Obstacles to HBV functional cure: Late presentation in HIV and its impact on HBV seroconversion in HIV/HBV coinfection

Abstract

Several cohorts have shown that long‐term tenofovir‐containing combination antiretroviral therapy (cART) leads to higher HBsAg seroclearance rates in HIV/HBV coinfected patients vs HBV‐monoinfected patients under tenofovir disoproxil fumarate (TDF)‐based therapy. We have analysed data on determinants of HBsAg loss in a retrospective multicentric cohort of 359 HIV/HBV coinfected patients. Median CD4 T‐cell count at baseline was 359/ul (321‐404), CDC stage was C in 20% (n = 70). Most patients (68%) were ART‐naïve when TDF‐ or tenofovir alafenamide (TAF)‐containing cART was initiated (baseline). After a median follow‐up of 11 years HBsAg loss had occurred in 66/359 (18%) patients. However, patients with stage CDC C (P ≤ .001), lower CD4 gain (P = .043) and not receiving TDF/FTC (P = .008) were less likely to lose HBsAg. Long‐term TDF‐containing cART appears to achieve higher rates of HBsAg seroclearance compared to published data for HBV monoinfected subjects. However, late presentation for HIV and poor immune recovery significantly impair HBV seroconversion rates.

Functional Cure of Hepatitis B Virus Infection in Individuals With HIV-Coinfection: A Literature Review

“…These studies and others have also evaluated HBsAg-seroclearance rates during ART containing an anti-HBV agent [17][18][19][20][21][22][23][24][25][27][28][29][30]. These rates are summarized in Figure 1b.…”

“…These studies and others have also evaluated HBsAg-seroclearance rates during ART containing an anti-HBV agent [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 ]. These rates are summarized in Figure 1 b. HBsAg-seroclearance occurs at a fairly low median rate of 2.39 per 100 person-years and within 5 years of therapy, 8–10% of individuals lose their HBsAg-positive status.…”

High rates of hepatitis B virus (HBV) functional cure among HIV/HBV coinfected Chinese adults on antiretroviral therapy

“…The higher incidence of HBsAg loss might possibly be attributed to the relatively long-time follow-up. In comparison, the Zambian cohort was followed up for just 2 years (10% of HBsAg loss), while the American and German cohorts were observed for 7.3 (10% of HBsAg loss) and 11 years (18% of HBsAg loss), [10][11][12] respectively. The median time to HBsAg loss in our study was 6.7 years, indicating that longer durations of HBV-active ART may lead to higher rates of HBsAg loss in HIV/HBV coinfection.…”

“…Although HIV inhibits the host immune response which becomes vulnerable to chronic HBV infection, functional cure in HIV/HBV coinfected individuals treated with tenofovir disoproxil fumarate (TDF)-based ART and immunological recovery seems to be more achievable than in those with HBV mono-infection [7] . Recent studies indicate that cumulative HBsAg loss rates varied between 10% and 18% in developed countries after long-term HBV-active ART [10–13] . Thus far, however, HBsAg loss and its determinants are rarely studied in China, particularly in individuals coinfected with HIV/HBV receiving long-term ART.…”

HBV co-infection is associated with persistently elevated liver stiffness measurement in HIV-positive adults: A 6-year single-centre cohort study in Nigeria

“…The attrition could have resulted in a retention of only the healthiest individuals which could have biased our results. The small HIV-HBV co-infected sample limited robust analysis of differences in risk factors and clinical outcomes associated with LSM in this group and a number of other risk factors (drug use, herb use, HDV co-infection, HBsAg sero-conversion [47]) were not examined. The finding of a lack of ART effect may have also been limited by the small number of patients.…”