title: Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected patients following antiretroviral therapy interruption.
abstract: BACKGROUND
  The impact of antiretroviral therapy (ART) interruption in HIV-hepatitis B virus (HBV)-coinfected patients was examined in the Strategic Management of AntiRetroviral Therapy (SMART) study.
  
  
  METHODS
  Plasma HBV DNA was measured in all hepatitis B surface antigen-positive (HBV-positive) participants at baseline, and at months 1, 2, 4, 6, 8, 10, and 12.
  
  
  RESULTS
  Among HBV-positive participants in the ART interruption (drug conservation) (n = 72) and ART continuation (virological suppression) (n = 62) arms, HBV DNA rebound of more than 1 log from baseline at months 1-4 was seen in 31-33% (P = 0.003) and 3-4% (P = 0.017), respectively. Thirteen HBV-positive participants had HBV DNA rebound of more than 3 log, including 12 in the drug conservation arm, of which eight were on tenofovir-containing regimens. Factors independently associated with a HBV DNA rebound were drug conservation arm (P = 0.0002), nondetectable HBV DNA at baseline (P = 0.007), and black race (P = 0.03). Time to ART reinitiation was shorter (7.5, 15.6, and 17.8 months; P < 0.0001) and proportion reinitiating greater (62.5, 46.5, and 39.7%; P = 0.0002) among HBV-positive participants as compared with hepatitis C virus-positive and non-HBV/hepatitis C virus participants in the drug conservation arm. No hepatic decompensation events occurred among HBV-positive participants in either arm.
  
  
  CONCLUSIONS
  HBV DNA rebound following ART interruption is common and may be associated with accelerated immune deficiency in HIV-HBV-coinfected patients.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia. gdore@nchecr.unsw.edu.au
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dore
authors.forename: Vicente
authors.initials: V
authors.lastname: Soriano
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rockstroh
authors.forename: Bernd
authors.initials: B
authors.lastname: Kupfer
authors.forename: Ellen
authors.initials: E
authors.lastname: Tedaldi
authors.forename: Lars
authors.initials: L
authors.lastname: Peters
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Neuhaus
authors.forename: Massimo
authors.initials: M
authors.lastname: Puoti
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D004279:DNA, Viral / Q000276:immunology; D024882:Drug Resistance, Viral / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D004279:DNA, Viral