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Tenofovir/emtricitabine topped other regimens for patients coinfected with HIV, HBV

Combining tenofovir disoproxil fumarate with emtricitabine resulted in greater long-term hepatitis B virus suppression than other treatments among patients coinfected with HIV and HBV in a recent study.

In a multinational longitudinal study, researchers collected data from 165 HIV/HBV-coinfected patients from the United States, Australia and Thailand. The majority of the cohort (90.3%) either used or planned to use highly active antiretroviral therapy (HAART) within 1 year of study initiation. Patient follow-up occurred every 6 months for a median of 2.8 years, resulting in 1,015 study visits. Using logistic regression, researchers determined factors associated with detectable HBV DNA (characterized as greater than 357 IU/mL).

Fifty-seven percent of patients used tenofovir disoproxil fumarate (TDF) in combination with emtricitabine (FTC) or lamivudine (LMV) as the primary anti-HBV HAART. LMV or FTC was prescribed for 19% of patients, and 13% of participants took TDF monotherapy.

Across the entire cohort, 48.7% of patients were hepatitis B e antigen (HBeAg) positive at baseline, and 29% displayed detectable HBV DNA. During follow-up, HBV DNA detection occurred at 20.8% of visits. Under multivariate analysis it was significantly associated with HBeAg positivity (OR=18.95; 95% CI, 9.0-39.88), less than 2 years of HAART (OR=3.07; 95% CI, 1.51-6.24), CD4 count of less than 200 cells/mm3 (OR=2.21; 95% CI, 1.30-3.77) and detectable HIV RNA (OR=4.51; 95% CI, 2.68-7.57).

Patients on TDF and FTC were less likely to display detectable HBV DNA than those on other therapies, including TDF monotherapy (OR=2.79; 95% CI, 1.17-6.64) and FTC/LMV (OR=6.59; 95% CI, 3.14-13.86). Researchers also observed HBV patterns of suboptimal response for TDF patients with persistent HBV viremia, viral rebound (less than log 1 from nadir) and viral blips.

“This study demonstrates that in HIV-HBV-coinfected subjects with prior LMV experience, combination therapy with TDF and FTC/LMV increases the likelihood for sustained HBV DNA suppression,” the researchers concluded. “Emphasizing the importance of full adherence to maintain both HIV and HBV control is critical in HIV-HBV-coinfected individuals.”

Disclosure: See the study for a full list of relevant disclosures.