title: Impact of lamivudine on the risk of liver-related death in 2,041 HBsAg- and HIV-positive individuals: results from an inter-cohort analysis.
abstract: BACKGROUND
  The impact of lamivudine (3TC) as part of combination antiretroviral therapy (cART) on the risk of liver-related death (LRD) in HIV/hepatitis B virus (HBV)-coinfected patients has not been extensively studied.
  
  
  METHODS
  We performed an analysis involving HIV/HBV-coinfected patients in 13 cohorts who initiated cART. The end-point was LRD--that is, death with concomitant decompensated liver disease (DLD) or hepatocellular carcinoma--as the main cause. Incidence rates of LRD after initiation of cART were expressed as number of events per 100 person-years of follow-up (PYFU). A Poisson regression model adjusted for cohort, gender, mode of HIV transmission, CD4+ T-cell count at cART initiation, liver disease pre-cART, duration of 3TC before cART, and hepatitis C virus was used to assess the association between use of 3TC and risk of LRD.
  
  
  RESULTS
  We analysed 2,041 patients. Follow-up after starting cART was 7,648 PYFU (5,569 spent on 3TC-containing regimens) with a median per person of 48 months (range: 2-91). Of the total, 217 subjects died; 57 deaths were liver-related resulting in a rate of 7.5 per 1,000 PYFU [95% confidence intervals (CI): 5.6-9.7]. The relative risk of LRD per extra year of 3TC use was 0.73 (95% CI: 0.59-0.90, P = 0.004).
  
  
  CONCLUSIONS
  The use of 3TC was associated with a reduced risk of LRD over 4 years of follow-up. This study supports the current view that the use of 3TC as part of cART should be considered in patients who are tested positive for HBsAg.
authors.affiliation: Clinica di Malattie Infettive e Tropical, Università degli Studi di Brescia, Brescia, Italy. m.puoti@iol.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Puoti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cozzi-Lepri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Paraninfo
authors.forename: Claudio
authors.initials: C
authors.lastname: Arici
authors.forename: Nina Friis
authors.initials: NF
authors.lastname: Moller
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Bruno
authors.initials: B
authors.lastname: Ledergerber
authors.forename: Martin
authors.initials: M
authors.lastname: Rickenbach
authors.forename: Ignacio
authors.initials: I
authors.lastname: Suarez-Lozano
authors.forename: Myriam
authors.initials: M
authors.lastname: Garrido
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Maria
authors.initials: M
authors.lastname: Winnock
authors.forename: Laura
authors.initials: L
authors.lastname: Milazzo
authors.forename: Anne
authors.initials: A
authors.lastname: Gervais
authors.forename: Francois
authors.initials: F
authors.lastname: Raffi
authors.forename: John
authors.initials: J
authors.lastname: Gill
authors.forename: Juergen
authors.initials: J
authors.lastname: Rockstroh
authors.forename: Nazifa
authors.initials: N
authors.lastname: Ourishi
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
authors.forename: Antonella d'Arminio
authors.initials: Ad
authors.lastname: Monforte
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006509:Hepatitis B / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006514:Hepatitis B Surface Antigens / Q000097:blood; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine