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J Acquir Immune Defic Syndr. 2014 May 1;66(1):96-101. doi: 10.1097/QAI.0000000000000126.

Factors associated with delayed hepatitis B viral suppression on tenofovir among patients coinfected with HBV-HIV in the CNICS cohort.

Author information

1
*Department of Medicine, University of Washington, Seattle, WA; †Departments of Medicine, Epidemiology, University of North Carolina, Chapel Hill, NC; ‡Department of Medicine, Johns Hopkins University, Baltimore, MD; §Department of Medicine, University of Alabama, Birmingham, AL; ‖University of California, San Francisco, San Francisco, CA; ¶Department of Medicine, Case Western Reserve University, Cleveland, OH; #Department of Medicine, University of California, San Diego, La Jolla, CA; and **Department of Medicine, Harvard University and Fenway Community Health, Boston, MA.

Abstract

BACKGROUND:

Despite widespread use in HIV and hepatitis B virus (HBV) infection, the effectiveness of tenofovir (TDF) has not been studied extensively outside of small cohorts of coinfected patients with HBV-HIV. We examined the effect of prior lamivudine (3TC) treatment and other factors on HBV DNA suppression with TDF in a multisite clinical cohort of coinfected patients.

METHODS:

We studied all patients enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems cohort from 1996 to 2011 who had chronic HBV and HIV infection, initiated a TDF-based regimen continued for ≥ 3 months and had on-treatment HBV DNA measurements. We used Kaplan-Meier curves and Cox-proportional hazards to estimate time to suppression (HBV DNA level <200 IU/mL or <1000 copies/mL) by selected covariates.

RESULTS:

Among 397 coinfected patients on TDF, 91% were also on emtricitabine or 3TC concurrently, 92% of those tested were hepatitis B e antigen positive, 196 (49%) had prior 3TC exposure; 192 (48%) achieved HBV DNA suppression over a median of 28 months (interquartile range: 13-71). Median time to HBV DNA suppression was 17 months for those who were 3TC-naive and 50 months for those who were 3TC exposed. After controlling for other factors, prior 3TC exposure, baseline HBV DNA level >10,000 IU/mL, and lower nadir CD4 count were independently associated with decreased likelihood of HBV DNA suppression on TDF.

CONCLUSIONS:

These results emphasize the role of prior 3TC exposure and immune response on delayed HBV suppression on TDF.

PMID:
24500175
PMCID:
PMC3981874
DOI:
10.1097/QAI.0000000000000126
[Indexed for MEDLINE]
Free PMC Article
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