Patterns and causes of suboptimal response to tenofovir-based therapy in individuals coinfected with HIV and hepatitis B virus

Gail V. Matthews, Eric C. Seaberg, Anchalee Avihingsanon, Scott Bowden, Gregory J. Dore, Sharon R. Lewin, Joe Sasadeusz, Peter A. Revill, Margaret Littlejohn, Jennifer F. Hoy, Robert Finlayson, Kiat Ruxrungtham, Melissa Saulynas, Stephen Locarnini, Chloe L. Thio

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Tenofovir (TDF) is effective for treatment of hepatitis B virus (HBV) in human immunodeficiency virus (HIV) infection; however, some individuals have ongoing HBV viremia, the reasons for which are unclear. We determined the patterns and factors associated with detectable HBV DNA in HIV-HBV-coinfected subjects on highly active antiretroviral therapy (HAART).Methods. One hundred sixty-five HIV-HBV-coinfected individuals from the United States, Australia, and Thailand, the majority of whom were on HAART at study entry, were prospectively followed semiannually for a median of 2.8 years. Logistic regression was used to determine factors associated with detectable HBV DNA.Results. Anti-HBV regimens were TDF/emtricitabine (57%), lamivudine or emtricitabine (19%), or TDF monotherapy (13%). During follow-up, HBV DNA was detected at 21% of study visits and was independently associated with hepatitis B e antigen (HBeAg), HAART <2 years, CD4 <200 cells/mm3, detectable HIV RNA, reporting <95% adherence, and anti-HBV regimen. TDF/emtricitabine was less likely to be associated with detectable HBV than other regimens, including TDF monotherapy (odds ratio, 2.79; P =. 02). In subjects on optimal anti-HBV therapy (TDF/emtricitabine) and with undetectable HIV RNA, HBeAg, CD4 <200 mm3, and reporting <95% adherence remained associated with detectable HBV DNA. Three main patterns of HBV viremia were observed: persistent HBV viremia, viral rebound (>1 log from nadir), and viral blips. No TDF resistance was identified.Conclusions. Tenofovir/ emtricitabine was superior to other anti-HBV regimens in long-term HBV suppression. HBV viremia on therapy was identified in 1 of 3 main patterns. Suboptimal adherence was associated with detectable HBV DNA during therapy, even when HIV was undetectable.

Original languageEnglish (US)
Pages (from-to)e87-e94
JournalClinical Infectious Diseases
Volume56
Issue number9
DOIs
StatePublished - May 1 2013

Keywords

  • HIV
  • adherence
  • antiretroviral therapy
  • hepatitis B

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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