title: Liver Fibrosis by Transient Elastography and Virologic Outcomes After Introduction of Tenofovir in Lamivudine-Experienced Adults With HIV and Hepatitis B Virus Coinfection in Ghana.
abstract: BACKGROUND
  Antiretroviral treatment (ART) programs in sub-Saharan Africa have for many years included lamivudine as the sole hepatitis B virus (HBV) inhibitor. Long-term outcomes and the effects of introducing tenofovir as part of ART in these populations have not been characterized.
  
  
  METHODS
  The study comprised a cross-sectional analysis of 106 human immunodeficiency virus (HIV)/HBV-coinfected subjects maintained on lamivudine, as well as a prospective analysis of 76 lamivudine-experienced subjects who introduced tenofovir. Patients underwent assessment of liver fibrosis by transient elastography (TE) and testing to characterize HIV type 1 (HIV-1) and HBV replication.
  
  
  RESULTS
  After a median of 45 months of lamivudine treatment, HIV-1 RNA and HBV DNA were detectable in 35 of 106 (33.0%) and 54 of 106 (50.9%) subjects, respectively, with corresponding drug resistance rates of 17 of 106 (16.0%) and 31 of 106 (29.2%), respectively. Median TE values were 5.7 kPa (interquartile range, 4.7-7.2 kPa) and independently associated with HBV DNA load, aspartate aminotransferase levels, and platelet counts; 13 of 106 (12.3%) subjects had TE measurements >9.4 kPa. Twelve months after the first assessment, and a median of 7.8 months after introducing tenofovir, HBV DNA levels declined by a mean of 1.5 log10 IU/mL (P < .001). TE values changed by a mean of -0.2 kPa (P = .097), and declined significantly in subjects who had pretenofovir HBV DNA levels >2000 IU/mL (mean, -0.8 kPa; P = .048) or TE values >7.6 kPa (mean, -1.2 kPa; P = .021). HIV-1 RNA detection rates remained unchanged.
  
  
  CONCLUSIONS
  A proportion of HIV/HBV-coinfected patients on long-term lamivudine-containing ART had poor HIV and HBV suppression, drug resistance, and TE values indicative of advanced liver fibrosis. Tenofovir improved HBV control and reduced liver stiffness in subjects with high HBV DNA load and TE values.
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, United Kingdom.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Stockdale
authors.affiliation: Department of Medicine, Kwame Nkrumah University of Science and Technology Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Richard Odame
authors.initials: RO
authors.lastname: Phillips
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, United Kingdom.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Beloukas
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Lambert Tetteh
authors.initials: LT
authors.lastname: Appiah
authors.affiliation: Centre for Clinical Infection, James Cook University Hospital, Middlesbrough.
authors.forename: David
authors.initials: D
authors.lastname: Chadwick
authors.affiliation: Department of Infectious Diseases, Royal Free Hospital, London.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhagani
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, United Kingdom Department of Biostatistics, University of Liverpool.
authors.forename: Laura
authors.initials: L
authors.lastname: Bonnett
authors.affiliation: Department of Medicine, Kwame Nkrumah University of Science and Technology Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Fred Stephen
authors.initials: FS
authors.lastname: Sarfo
authors.affiliation: Division of Medicine, University College London, United Kingdom.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dusheiko
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, United Kingdom.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Geretti
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D000998:Antiviral Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D005869:Ghana; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000068698:Tenofovir / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine; D000068698:Tenofovir
keywords: Africa; hepatitis B; lamivudine; tenofovir; transient elastography