title: Lamivudine Monotherapy-Based cART Is Efficacious for HBV Treatment in HIV/HBV Coinfection When Baseline HBV DNA <20,000 IU/mL.
abstract: BACKGROUND
  Although combination antiretroviral therapy (cART) including tenofovir (TDF)+lamivudine (3TC) or emtricitabine (FTC) is recommended for treatment of HIV/HBV coinfected patients, TDF is unavailable in some resource-limited areas. Some data suggest that 3TC monotherapy-based cART may be effective in patients with low pretreatment HBV DNA.
  
  
  METHODS
  Prospective study of 151 Chinese HIV/HBV coinfected subjects of whom 60 received 3TC-based cART and 91 received TDF+3TC-based cART. Factors associated with HBV DNA suppression at 24 and 48 weeks, including anti-HBV drugs, baseline HBV DNA, and baseline CD4 cell count, were evaluated overall and stratified by baseline HBV DNA using Poisson regression with a robust error variance.
  
  
  RESULTS
  Baseline HBV DNA ≥20,000 IU/mL was present in 48.3% and 44.0% of subjects in the 3TC and TDF groups, respectively (P = 0.60). After 48 weeks of treatment, HBV DNA suppression rates were similar between these 2 groups (96.8% vs. 98.0% for 3TC and TDF+3TC, P > 0.999) in subjects with baseline HBV DNA <20,000 IU/mL; whereas in those with baseline HBV DNA ≥20,000 IU/mL, TDF+3TC was associated with higher suppression rates (34.5% vs. 72.5% in 3TC and TDF+3TC groups, respectively, P = 0.002). In stratified multivariate regression, TDF use (RR 1.98, P = 0.010) and baseline HBV DNA (per 1 log increase in International Units Per Milliliter, RR 0.74, P < 0.001) were associated with HBV DNA suppression only when baseline HBV DNA ≥20,000 IU/mL.
  
  
  CONCLUSIONS
  This study suggests that 3TC monotherapy-based cART is efficacious for HBV treatment through 48 weeks in HIV/HBV coinfection when baseline HBV DNA <20,000 IU/mL. Studies with long-term follow-up are warranted to determine if this finding persists.
authors.affiliation: *Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China; and †Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Yijia
authors.initials: Y
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.forename: Yang
authors.initials: Y
authors.lastname: Han
authors.forename: Huanling
authors.initials: H
authors.lastname: Wang
authors.forename: Ting
authors.initials: T
authors.lastname: Zhu
authors.forename: Nidan
authors.initials: N
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Lv
authors.forename: Fuping
authors.initials: F
authors.lastname: Guo
authors.forename: Zhifeng
authors.initials: Z
authors.lastname: Qiu
authors.forename: Yanling
authors.initials: Y
authors.lastname: Li
authors.forename: Shanshan
authors.initials: S
authors.lastname: Du
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Song
authors.forename: Chloe L
authors.initials: CL
authors.lastname: Thio
authors.forename: Taisheng
authors.initials: T
authors.lastname: Li
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002681:China; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy* / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D004359:Drug Therapy, Combination; D000068679:Emtricitabine / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000068698:Tenofovir / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D019259:Lamivudine; D000068698:Tenofovir; D000068679:Emtricitabine