Factors associated with delayed hepatitis B viral suppression on tenofovir among patients coinfected with HBV-HIV in the CNICS cohort.
BACKGROUND
Despite widespread use in HIV and hepatitis B virus (HBV) infection, the effectiveness of tenofovir (TDF) has not been studied extensively outside of small cohorts of coinfected patients with HBV-HIV. We examined the effect of prior lamivudine (3TC) treatment and other factors on HBV DNA suppression with TDF in a multisite clinical cohort of coinfected patients.


METHODS
We studied all patients enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems cohort from 1996 to 2011 who had chronic HBV and HIV infection, initiated a TDF-based regimen continued for ≥ 3 months and had on-treatment HBV DNA measurements. We used Kaplan-Meier curves and Cox-proportional hazards to estimate time to suppression (HBV DNA level <200 IU/mL or <1000 copies/mL) by selected covariates.


RESULTS
Among 397 coinfected patients on TDF, 91% were also on emtricitabine or 3TC concurrently, 92% of those tested were hepatitis B e antigen positive, 196 (49%) had prior 3TC exposure; 192 (48%) achieved HBV DNA suppression over a median of 28 months (interquartile range: 13-71). Median time to HBV DNA suppression was 17 months for those who were 3TC-naive and 50 months for those who were 3TC exposed. After controlling for other factors, prior 3TC exposure, baseline HBV DNA level >10,000 IU/mL, and lower nadir CD4 count were independently associated with decreased likelihood of HBV DNA suppression on TDF.


CONCLUSIONS
These results emphasize the role of prior 3TC exposure and immune response on delayed HBV suppression on TDF.
*Department of Medicine, University of Washington, Seattle, WA; †Departments of Medicine, Epidemiology, University of North Carolina, Chapel Hill, NC; ‡Department of Medicine, Johns Hopkins University, Baltimore, MD; §Department of Medicine, University of Alabama, Birmingham, AL; ‖University of California, San Francisco, San Francisco, CA; ¶Department of Medicine, Case Western Reserve University, Cleveland, OH; #Department of Medicine, University of California, San Diego, La Jolla, CA; and **Department of Medicine, Harvard University and Fenway Community Health, Boston, MA.
H Nina
HN
Kim
Carla V
CV
Rodriguez
Stephen
S
Van Rompaey
Joseph J
JJ
Eron
Chloe L
CL
Thio
Heidi M
HM
Crane
Edgar T
ET
Overton
Michael S
MS
Saag
Jeffrey
J
Martin
Elvin
E
Geng
Michael
M
Mugavero
Benigno
B
Rodriguez
W Christopher
WC
Mathews
Stephen
S
Boswell
Richard
R
Moore
Mari M
MM
Kitahata
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use*; D000068698:Tenofovir; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine