Nonadherence common with HBV antiviral therapy

SAN FRANCISCO — Nonadherence was high among Brazilian patients receiving antiviral treatment for chronic hepatitis B virus infection, according to data presented at The Liver Meeting 2015.

Rodrigo M. Abreu, MD, of the department of gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil, and colleagues conducted a prospective cohort study with 183 patients with chronic HBV enrolled at a Brazilian reference tertiary hospital treated with adefovir, entecavir, lamivudine and/or tenofovir. Each patient participated in a questionnaire known as CEAT-HBV, which assisted in determining adherence to HBV antiviral therapy.

Overall, CEAT-HBV identified 57% of patients with HBV treatment adherence (n = 104).

Rodrigo M. Abreu

Analyses showed that among 79 patients with nonadherence to antiviral treatment, 53 had a positive viral load of HBV, including frequency of the following HBV genotypes: A (14%), A1 (34%), A2 (3%), C (18%) and D (14%).

“However, 38% (70/183) had positive viral loads, suggesting nonresponse to antiviral treatment,” the researchers wrote

In the adherence group with positive viral load, 64% had HBV with drug resistance mutations (9/14). In patients with positive viral load and nonadherence, 83% had drug resistance HBV mutations (33/40).

Factors responsible for nonresponse to antiviral treatment were drug-resistant mutations in HBV (51%), nonadherence without drug-resistant mutations (37%), short treatment duration (8%) and nondetermined (4%), according to the abstract.

CEAT-HBV results 2 years after the initial evaluation showed that 74.1% of patients were treatment adherent (104/143). The other 40 patients were excluded because they were either lost to follow-up, died due to hepatocellular carcinoma (n = 10) or for other unknown reasons.

“It is worth noting that these 10 dead persons were adherent to antiviral treatment and had undetectable HBV DNA,” Abreu and colleagues wrote.

The researchers concluded: “Drug resistance mutations and nonadherence to anti-HBV therapy were the main cause of treatment failure in CHB individuals. This study demonstrates the urgency to implement more effective procedures to improve adherence to antiviral treatment for chronic hepatitis B.” – by Melinda Stevens

Reference:

Abreu RM, et al. Abstract 1544. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.

Disclosures: Abreu reports no relevant financial disclosures. Please see the abstract for a full list of all other authors’ relevant financial disclosures.