Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected patients following antiretroviral therapy interruption.
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.
Dore
Gregory J
GJ
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia. gdore@nchecr.unsw.edu.au
Soriano
Vicente
V
Rockstroh
Jürgen
J
Kupfer
Bernd
B
Tedaldi
Ellen
E
Peters
Lars
L
Neuhaus
Jacqueline
J
Puoti
Massimo
M
Klein
Marina B
MB
Mocroft
Amanda
A
Clotet
Bonaventura
B
Lundgren
Jens D
JD
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
D004279:DNA, Viral