Combination Antiretroviral Therapy is Well-tolerated and Rapidly Suppresses HBV Viral Load in HIV-HBV Coinfected Patients

By Liz Highleyman

Due to overlapping transmission routes, many HIV positive people have also been exposed to hepatitis B virus (HBV), and an estimated 10% have chronic HIV-HBV coinfection.

At the 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009) last month in Copenhagen, Austrian researchers presented data from a study of highly active antiretroviral therapy (HAART) in coinfected patients, showing that HIV-HBV coinfected people tolerate HAART well and achieve outcomes as good as those of HIV negative people with hepatitis B alone.

Three antiretroviral drugs often used to treat HIV -- lamivudine (3TC; Epivir), emtricitabine (FTC; Emtriva), and tenofovir (Viread, also in the Truvada and Atripla combination pills) -- are also active against HBV Treatment guidelines recommend that HIV-HBV coinfected individuals should include these drugs in their regimen.

The present retrospective analysis included 100 HIV-HBV coinfected participants treated at the HIV outpatient clinic at the Medical University of Vienna between 1998 and 2008. About two-thirds (64%) were hepatitis B "e" antigen (HBeAg) positive. Most (82%) were receiving HAART, with 63% taking tenofovir, 46% taking lamivudine, and 31% taking emtricitabine.

Results

Before starting HAART, the mean HBV DNA level was about 4,500,000,000 IU/mL.

HBeAg positive patients had a significantly higher average HBV viral load than HBeAg negative individuals (about 7,500,000,000 vs about 2,00,000,000 IU/mL, respectively).

Over a median observation period of 68 month (range 2-171), 73% of study participants achieved complete HBV DNA suppression (lower limit of detection 351 IU/mL).

Overall, 63% patients experienced HBeAg seroconversion, for an annual probability of 11%.

The cumulative annual rate of hepatitis B surface-antigen (HBsAg) loss was 6.6% among HBeAg positive patients and 8.7% among HBeAg negative patients.

12% of participants experienced transient aminotransferases (ALT or AST) elevations after starting HAART.

However, there were no instances of serious (grade 3 or 4) liver toxicity.

"HAART treatment in HBV-HIV coinfected patients is well tolerated and leads to rapid suppression of HBV replication despite high baseline viremia," the investigators concluded. "Rates of HBeAg seroconversion and HBsAg loss in HBV-HIV coinfected patients are comparable to or even higher than in HBV mono-infected patients."

Gastroenterology & Hepatology, Dermatology, Division of Infectious Diseases, Medical University of Vienna, Vienna, Austria.

5/08/09

Reference
L Kosi, T Reiberger, K Rutter, and others.Efficacy of highly active anti-retroviral therapy (HAART) in patients with HBV-HIV co-infection. 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009). Copenhagen, Denmark. April 22-26, 2009.

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