Hepatitis B Treatment Improves Liver Disease in HIV/HBV Coinfected

SUMMARY: Dual-acting nucleoside/nucleotide analogs including tenofovir (Viread) suppressed HBV viral load and slowed liver disease progression in HIV positive patients in Spanish study.

By Liz Highleyman

Due to overlapping transmission methods, many people with HIV are also exposed to hepatitis B virus (HBV), and some develop chronic HIV/HBV coinfection. Over time, hepatitis B can lead to advanced liver fibrosis, cirrhosis, and hepatocellular carcinoma (liver cancer). On average, HIV/HBV coinfected individuals experience more rapid liver disease progression than people with HBV alone.

Treatment guidelines recommend that coinfected patients should receive antiretroviral therapy (ART) regimens that contain drugs with dual activity against both HIV and HBV, which include tenofovir (Viread, also in the Truvada and Atripla coformulations), lamivudine (3TC, Epivir), and emtricitabine (Emtriva).

As described in the January 2, 2011, issue of AIDS, Luz Martin-Carbonero from Hospital Carlos III in Madrid and colleagues evaluated the long-term effects of dually active nucleoside/nucleotide analogs in a cohort of coinfected patients in Spain.

Over a median follow-up period of 35 months, the researchers retrospectively analyzed changes in HBV DNA viral load, hepatitis B "e" antigen (HBeAg) and hepatitis B surface antigen (HBsAg), and clinical outcomes including fibrosis progression (estimated using the non-invasive FibroScan method), hepatocellular carcinoma, decompensation or liver failure, and death.

The analysis included 92 patients with HIV/HBV coinfection; about 30% also had hepatitis C virus (HCV) and about 20% were also infected with hepatitis delta virus (HDV). Most (88%) were men, the median age was 41 years, and 45% were initially HBeAg positive. At baseline, 48% had absent or mild liver fibrosis, 28% had moderate-to-advanced fibrosis, and 24% had cirrhosis. Overall, 94% received ART containing lamivudine or emtricitabine, and 82% used tenofovir.

Results

13 patients were lost to follow-up, leaving 79 included in the analysis.

71 of 79 participants, or 89%, achieved undetectable HBV DNA.

11 of the 42 HBeAg positive patients cleared HBeAg (9.0 per 100 person-years), and 5 also experienced anti-HBe antibody seroconversion.

7 participants experienced HBsAg clearance (2.6 per 100 person-years), 4 of whom also had anti-HBs antibody seroconversion; 2 people in this group were triply infected with HDV.

During follow-up 8 patients -- half of whom also had HDV -- progressed to liver decompensation (2.9 per 100 person-years) and 1 developed hepatocellular carcinoma.

6 patients died (2.2 per 100 person-years), with 4 deaths attributable to liver disease.

Among 71 patients who received follow-up FibroScan evaluations after a median of 40 months:

	75% showed no changes in fibrosis stage;
	17% experienced improvement;
	17% showed worsening fibrosis.

HCV triple infection and low CD4 T-cell count were significant risk factors for liver cirrhosis.

Based on these findings, the study authors concluded, "Most HIV/HBV-coinfected patients treated with anti-HBV active [nucleoside/nucleotide analogs] experience an amelioration of liver fibrosis progression, with low rates of hepatic decompensation and death."

"Serum HBeAg or HBsAg seroconversion occurs at yearly rates of 9[%] and 2.6%, respectively, even in patients with delta hepatitis," they added.

Nevertheless, they noted, "oral [nucleoside/nucleotide analogs] do not entirely annul the risk of hepatic decompensation events or death in this population, including the development of hepatocellular carcinoma."

Investigator affiliation: Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.

3/29/11

Reference
L Martin-Carbonero, T Teixeira, E Poveda, et al. Clinical and virological outcomes in HIV-infected patients with chronic hepatitis B on long-term nucleos(t)ide analogues. AIDS 25(1): 73-79 (abstract). January 2, 2011.