title: Tenofovir-based antiretroviral therapy in  HBV-HIV coinfection: results from the TREAT Asia HIV Observational Database.
abstract: BACKGROUND
  The World Health Organization recommends HBV-HIV-coinfected individuals start antiretroviral therapy containing tenofovir. Here we describe first-line tenofovir use and treatment outcomes in coinfected patients in Asia.
  
  
  METHODS
  HBV surface antigen positive patients enrolled in the TREAT Asia HIV Observational Database who started first-line antiretroviral therapy were included. Logistic regression adjusted for period of treatment initiation was used to determine factors associated with tenofovir use. Generalized estimating equations were used to evaluate factors associated with alanine transaminase levels and CD4(+) T-cell count on treatment.
  
  
  RESULTS
  There were 548 eligible patients, of whom 149 (27.2%) started tenofovir. Patients treated in high/high-middle income countries (odds ratio 4.4 versus low/low-middle, 95% CI 2.6, 7.4; P<0.001) and those with elevated baseline alanine transaminase (odds ratio 4.2 versus normal, 95% CI 2.4, 7.2; P<0.001) were more likely to receive tenofovir. Hepatitis C antibody positive patients (odds ratio 0.4 versus negative, 95% CI 0.2, 0.8; P=0.008) were less likely. In those starting antiretroviral therapy with elevated alanine transaminase, mean reduction after tenofovir initiation was 11.2 IU/l (95% CI 0.9, 21.6; P=0.034) lower compared with those using a non-tenofovir-based regimen although this did not significantly increase the chance of alanine transaminase normalization. Tenofovir use was not associated with a superior CD4(+) T-cell response.
  
  
  CONCLUSIONS
  HBV-HIV-coinfected patients in Asia are most likely to receive tenofovir if they are treated in a high/high-middle income country, have elevated alanine transaminase levels and are hepatitis C antibody negative. Compared to other antiretroviral therapies, tenofovir-based regimens more effectively reduce liver inflammation in HBV-HIV-coinfection but do not result in superior CD4(+) T-cell recovery.
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, Australia. dboettiger@kirby.unsw.edu.au.
authors.forename: David C
authors.initials: DC
authors.lastname: Boettiger
authors.forename: Stephen
authors.initials: S
authors.lastname: Kerr
authors.forename: Rossana
authors.initials: R
authors.lastname: Ditangco
authors.forename: Romanee
authors.initials: R
authors.lastname: Chaiwarith
authors.forename: Patrick Ck
authors.initials: PC
authors.lastname: Li
authors.forename: Tuti Parwati
authors.initials: TP
authors.lastname: Merati
authors.forename: Thuy Thi Thanh
authors.initials: TT
authors.lastname: Pham
authors.forename: Sasisopin
authors.initials: S
authors.lastname: Kiertiburanakul
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Saphonn
authors.initials: S
authors.lastname: Vonthanak
authors.forename: Christopher Kc
authors.initials: CK
authors.lastname: Lee
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Kinh
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pujari
authors.forename: Wing Wai
authors.initials: WW
authors.lastname: Wong
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
authors.forename: Evy
authors.initials: E
authors.lastname: Yunihastuti
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.forename: Oon Tek
authors.initials: OT
authors.lastname: Ng
authors.forename: Pacharee
authors.initials: P
authors.lastname: Kantipong
authors.forename: Mahiran
authors.initials: M
authors.lastname: Mustafa
authors.forename: Winai
authors.initials: W
authors.lastname: Ratanasuwan
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D015497:HIV-1; D006509:Hepatitis B / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006515:Hepatitis B virus; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D009026:Mortality; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D012307:Risk Factors; D000068698:Tenofovir / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir