title: Suppression of HBV by tenofovir in HBV/HIV coinfected patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Hepatitis B coinfection is common in HIV-positive individuals and as antiretroviral therapy has made death due to AIDS less common, hepatitis has become increasingly important. Several drugs are available to treat hepatitis B. The most potent and the one with the lowest risk of resistance appears to be tenofovir (TDF). However there are several questions that remain unanswered regarding the use of TDF, including the proportion of patients that achieves suppression of HBV viral load and over what time, whether suppression is durable and whether prior treatment with other HBV-active drugs such as lamivudine, compromises the efficacy of TDF due to possible selection of resistant HBV strains.
  
  
  METHODS
  A systematic review and meta-analysis following PRISMA guidelines and using multilevel mixed effects logistic regression, stratified by prior and/or concomitant use of lamivudine and/or emtricitabine.
  
  
  RESULTS
  Data was available from 23 studies including 550 HBV/HIV coinfected patients treated with TDF. Follow up was for up to seven years but to ensure sufficient power the data analyses were limited to three years. The overall proportion achieving suppression of HBV replication was 57.4%, 79.0% and 85.6% at one, two and three years, respectively. No effect of prior or concomitant 3TC/FTC was shown. Virological rebound on TDF treatment was rare.
  
  
  CONCLUSIONS
  TDF suppresses HBV to undetectable levels in the majority of HBV/HIV coinfected patients with the proportion fully suppressed continuing to increase during continuous treatment. Prior treatment with 3TC/FTC does not compromise efficacy of TDF treatment. The use of combination treatment with 3TC/FTC offers no significant benefit over TDF alone.
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom. huw.price@ucl.ac.uk
authors.forename: Huw
authors.initials: H
authors.lastname: Price
authors.forename: David
authors.initials: D
authors.lastname: Dunn
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.forename: Firouze
authors.initials: F
authors.lastname: Bani-Sadr
authors.forename: Theodora
authors.initials: T
authors.lastname: de Vries-Sluijs
authors.forename: Mamta K
authors.initials: MK
authors.lastname: Jain
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Kuzushita
authors.forename: Stefan
authors.initials: S
authors.lastname: Mauss
authors.forename: Marina
authors.initials: M
authors.lastname: Núñez
authors.forename: Reto
authors.initials: R
authors.lastname: Nüesch
authors.forename: Marion
authors.initials: M
authors.lastname: Peters
authors.forename: Thomas
authors.initials: T
authors.lastname: Reiberger
authors.forename: Christoph
authors.initials: C
authors.lastname: Stephan
authors.forename: Lionel
authors.initials: L
authors.lastname: Tan
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy* / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D063065:Organophosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine