Reconstitution of Hepatitis B Virus (HBV)–Specific T Cell Responses with Treatment of Human Immunodeficiency Virus/HBV Coinfection

Abstract

Liver-related mortality is an increasing problem in human immunodeficiency virus (HIV)/hepatitis B virus (HBV)-coinfected patients receiving highly active antiretroviral therapy (HAART). In HIV-negative patients, HBV chronicity is associated with a reduction in specific T cell responses that can be partially restored by treatment with lamivudine. We studied 5 HIV/HBV-coinfected patients treated with HAART, either with or without addition of a drug with specific anti-HBV activity. Our data show that reconstitution of some HBV-specific T cell responses can also occur in HIV-positive patients after a reduction in HBV load. This potential to recover T cell responses, which has been thought to be critical for HBV control, provides support for the addition of anti-HBV therapy in the treatment of HIV/HBV-coinfected patients.

Impact of Highly Active Antiretroviral Therapy (HAART) on the Natural History of Hepatitis B Virus (HBV) and HIV Coinfection: Relationship between Prolonged Efficacy of HAART and HBV Surface and Early Antigen Seroconversion

“…A previous immunologic study involving 5 patients coinfected with HIV and HBV found evidence of the reconstitution of a functionally active HBV-specific CD8 cell response when HAART was combined with an anti-HBV drug [14]. More recently [15], the same group demonstrated that an HBV-specific CD8 cell response had been reconstituted in 50% of the HIV-infected patients receiving HAART.…”

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

“…HBV-specific CD8 T-cell responses recover in patients on ART, but this has not been related to LEE (75,76). A lack of HBV-specific CD4 T-cell help in HIV-HBV-coinfected individuals may lead to an inefficient or dysregulated HBV-specific CD8 T-cell response and/or a greater role for innate immunity (24).…”

Natural history of chronic hepatitis B in co-infected patients

“…Independent of the use of lamivudine, HAART may induce reconstitution of the adaptive immune response and this is a 'double-edged sword' in patients infected with HBV: on one side, anecdotal reports suggest the induction of HBV seroconversion and therefore a better control of HBV replication with or without flares of necro-inflammatory activity [41][42][43][44]; on the other side, flares of necroinflammatory activity have been reported without modification of HBV markers and of HBV replication levels [45][46][47][48]. However, the incidence of HAART-induced HBsAg seroconversion has not been accurately determined, but occurred in one out of 24 HBsAg-positive patients prospectively followed during HAART in one of the largest published studies [49].…”