Treatment outcomes in a cohort of patients with chronic hepatitis B and human immunodeficiency virus co-infection in Mumbai, India

Abstract

CitationTreatment outcomes in a cohort of patients with chronic hepatitis B and human immunodeficiency virus coinfection in Mumbai, India 2012, 4 (4) Treatment experiences with patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in resource-limited settings remain poorly documented.This study aimed to evaluate the treatment outcomes in a cohort of HIV/HBV co-infected individuals receiving tenofovir/lamivudine (TDF/3TC)-based antiretroviral therapy (ART) in a programmatic setting in Mumbai, India. Additionally, a cross-sectional laboratory study was carried out measuring serologic and virologic parameters. A total of 57 patients who received TDF/3TC were included in the study. Of these, 52 (91%) were male and the mean age was 38.7 years. The median follow-up period was 16.8 months (IQR:7.9-37.9). Forty-three patients were included in the cross-sectional laboratory study, of whom 38 (67%) were HBeAg + positive. Four patients had serum HBsAg conversion to negative and had developed anti-HBs-antibodies. HBV-DNA became undetectable (<1.3 log 10 copies/ml or <20 IU/ml) in 35.5% and 75% of the HBeAg + and HBeAg − patients, respectively. Overall, 46.5% of patients had undetectable HBV-DNA and 90.7% had adequately suppressed HBV-DNA (<3.3 log 10 copies/ml or <2000 IU/ml). The median reduction in serum HBV-DNA was 6 log 10 copies/ml. In 29 patients (63%) HIV viral load was undetectable. Outcomes included seven (12%) deaths, four (7%) lost to follow-up, one (2%) transferred out and 45 (79%) alive and on treatment. In conclusion, good treatment outcomes were achieved in a cohort of HIV/HBV co-infected patients in India. In regions with a high HIV/HBV burden, all HIV-infected individuals should be tested for chronic hepatitis B. A TDF/3TC-backbone could be considered as first-line standardized ART regimen in these settings.

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

“…This can be explained by efficacy difference between the two treatment regimen; where TDF-3TC-EFV, a nucleotide analogue which inhibited the polymerase and viral replication, has more efficient than lamivudine (3TC) and Zidovudine(AZT) in the treatment of both HIV/AIDS and HBV [ 28 ].This was similar with a study conducted in Kenya [ 29 ]. Similarly, other studies also reported that TDF-3TC-EFV combined ART therapy significantly reduced the level of HBV DNA level in the patient’s serum [ 28 , 30 ]. another interesting result from the African Temprano Trial, presented at the conference on Retroviruses and Opportunistic Infection (CROI 2015), showed that starting HIV/AIDS treatment (TDF was one of the drugs they used) at a CD4 cell count above 500 reduced the risk of serious illness and death by 44 % when compared to starting treatment according to WHO guidelines [ 31 ].…”

Hepatitis B virus seromarkers among HIV infected adults on ART: An unmet need for HBV screening in eastern Ethiopia

“…A recent population-based HIV impact assessment (EPHIA 2017–2018) report in Ethiopia indicated a 4.8% HBV co-infection among adults of 15–64 years of age (3.6% in women to 7.4% in men) in urban Ethiopia using rapid diagnostic test [30]. The variations in prevalence reports may be attributed to ART exposure that could significantly reduce the level of HBV DNA [31], geographical variation of HBsAg carriage that range from 1.9% to over 40% [32] and mutations in the S region of HBV [6]. The difference in sample size and the diagnostic tools may also affect to the prevalence reports in Ethiopia.…”

“…Being single, history of genital discharge, and ART without TDF [31] were statistically significant predictors of HBsAg positivity. This study, did not find a statistically significant association between HBsAg positivity and many of the sociodemographic characteristics such age, sex, residence and level of education like other similar studies [18, 21, 22, 24, 55].…”

Current Scenario of Hepatitis B and Its Treatment in India

“… 82 Long-term treatment with LAM-based highly active antiretroviral therapy (HAART) cause a greater number of mutations 83 than tenofovir (TDF)-based HAART therapy, which gave better results. 84 Drug-resistant mutations reportedly occur in 3.8%. 77 …”