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Zhang Q, Wang H, Jin Y, Zhou N, Sun L, Wu H, Chen H, Jiang T. Incidence and predictors of HBV functional cure in patients with HIV/HBV coinfection: A retrospective cohort study. Front Cell Infect Microbiol 2023; 13:1130485. [PMID: 36844414 PMCID: PMC9944431 DOI: 10.3389/fcimb.2023.1130485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background This study was the first to examine the association of baseline clinical factors with the rate of HBsAg clearance in a large retrospective cohort of Chinese patients with HIV/HBV coinfection treated with combination antiretroviral therapy (ART). Methods Our retrospective cohort included 431 patients with HIV/HBV coinfection treated with TDF-containing ART. The median follow-up was 6.26 years. Logistic regression was used to investigate the association of baseline variables with HBsAg clearance, and Cox regression was used to investigate the association of baseline variables with time to HBsAg clearance. Results The clearance rate of HBsAg in our study was 0.072 (95% CI 0.049~0.101). In the multivariate logistic regression, advanced age (OR=1.1, P=0.007), high CD4 cell count (OR=2.06, P=0.05), and HBeAg positivity (OR=8.00, P=0.009) were significantly associated with the rate of HBsAg clearance. The AUC of the model integrating the above three predictors was 0.811. Similar results were found in the multivariate Cox regression (HR = 1.09, P = 0.038 for age, HR = 1.05, P = 0.012 for CD4 count and HR = 7.00, P = 0.007 for HBeAg). Conclusions Long-term TDF-containing ART can lead to HBsAg clearance of 7.2% in Chinese patients with HIV/HBV coinfection. Advanced age, high CD4 cell count, and positive HBeAg at baseline could be regarded as potential predictors and biological markers for HBsAg clearance in patients with HIV/HBV coinfection.
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Affiliation(s)
- Qingrong Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Hu Wang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yi Jin
- Medical Department, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Na Zhou
- School of Pharmacy, Macau University of Science and Technology, Macau, Macau SAR, China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau, Macau SAR, China
| | - Lijun Sun
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Haitao Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Taiyi Jiang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Taiyi Jiang,
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Challenges and opportunities for hepatitis B cure in the setting of HIV--hepatitis B virus co-infection. Curr Opin HIV AIDS 2021; 15:193-199. [PMID: 32141889 DOI: 10.1097/coh.0000000000000624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To examine issues specific to HIV--HBV co-infection that are relevant to the search for and achieving hepatitis B cure in this the setting RECENT FINDINGS: In HIV--HBV co-infection, high rates of hepatitis B surface antigen (HBsAg) loss early after initiation of HBV-active antiretroviral therapy (ART) have previously been reported. Between 2012 and 2016, HBsAg loss from 2.8 to 23% was reported in numerous studies, including those already on suppressive HBV-active ART. Data published in 2018-2019 show that these rates have remained fairly stable (3.0-13.9%). However, it appears that higher HBsAg loss on starting HBV-active ART in co-infection falls within a few years to levels similar to that observed in long-term treated HBV mono-infection. Immune reconstitution and CD4+ T-cell recovery are likely to play a role in high HBsAg loss rates seen in early treated co-infection, although the mechanisms driving this are yet to be fully elucidated. SUMMARY High rates of HBsAg loss early after HBV-active ART initiation is unique to HIV--HBV co-infection, making it the ideal setting to investigate underlying mechanisms of HBV loss and develop new HBV cure strategies. This phenomenon could be used to enhance HBsAg loss with new therapeutic approaches currently being investigated; however, this is obstructed by excluding co-infection from such studies.
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Boyd A, Dezanet LNC, Lacombe K. Functional Cure of Hepatitis B Virus Infection in Individuals With HIV-Coinfection: A Literature Review. Viruses 2021; 13:1341. [PMID: 34372547 PMCID: PMC8309973 DOI: 10.3390/v13071341] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022] Open
Abstract
In individuals infected with hepatitis B virus (HBV), the loss of hepatitis B surface antigen (HBsAg) is the ultimate therapeutic goal, which defines "functional cure." For individuals living with human immunodeficiency virus (HIV), functional cure occurs roughly 2 per 100 person-years during potent anti-HBV containing antiretroviral therapy. Although this rate may be higher than expected in treated HBV mono-infected individuals, rates of functional cure widely vary between studies (0.6-10.5 per 100 person-years). Similar to HBV mono-infection, the phase of HBV infection, HBV (sub-)genotypes and hepatitis B "e" Ag-negative variants are associated with functional cure in treated HIV-HBV co-infection. In specifically HIV-HBV co-infected individuals, strong increases in CD4+ T cell counts after treatment initiation have also been linked to functional cure, yet this finding is inconsistent across studies. Several markers directly or indirectly reflecting HBV activity are being developed to predict functional cure, such as quantification of HBsAg, hepatitis B core-related antigen, HBsAg protein composition, anti-hepatitis B core antibodies and interferon-gamma-inducible protein 10. Few have been assessed during treatment in HIV-HBV co-infected individuals and none have been validated to predict functional cure. Novel therapeutics for HBV cure are essential for individuals with HIV-HBV co-infection and need to be separately evaluated in this population.
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Affiliation(s)
- Anders Boyd
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands
- Stichting HIV Monitoring, 1105 BD Amsterdam, The Netherlands
| | - Lorenza N. C. Dezanet
- Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM, IPLESP, Sorbonne Université, 75012 Paris, France; (L.N.C.D.); (K.L.)
| | - Karine Lacombe
- Institut Pierre Louis d’Épidémiologie et de Santé Publique, INSERM, IPLESP, Sorbonne Université, 75012 Paris, France; (L.N.C.D.); (K.L.)
- APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, 75012 Paris, France
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4
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Jain MK, Vigil KJ, Parisot P, Go G, Vu T, Li X, Hansen L, Taylor BS. Incidence and Predictors of Hepatitis B Surface Antigen Clearance in HIV Patients: A Retrospective Multisite Study. Open Forum Infect Dis 2021; 8:ofab116. [PMID: 34337091 PMCID: PMC8320286 DOI: 10.1093/ofid/ofab116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 12/30/2022] Open
Abstract
Background New therapies to achieve hepatitis B surface antigen (HBsAg) clearance are under development. However, gaps in knowledge exist in understanding the incidence and predictors of HBsAg clearance in a racially diverse HIV population. Methods We examined the incidence and risk of HBsAg clearance in a retrospective cohort of people with HIV/hepatitis B virus (HBV). Included patients had sufficient data to establish chronic infection based on Centers for Disease Control and Prevention guidelines. We examined the incident rate for HBsAg loss and hazard rate ratios to evaluate predictors for HBsAg clearance in a multivariable model. Results Among 571 HIV/HBV patients, 87% were male, 61% were Black, 45% had AIDS, 48% were HBeAg positive, and the median follow-up was 88 months. Incident HBsAg clearance was 1.5 per 100 person-years. In the multivariate model, those with AIDS at baseline (adjusted hazard ratio [aHR], 2.43; 95% CI, 1.37–4.32), Hispanics (aHR, 3.57; 95% CI, 1.33–9.58), and those with injection drug use as an HIV risk factor (aHR, 3.35; 95% CI, 1.26–8.89) were more likely to lose HBsAg, whereas those who were HBeAg positive (aHR, 0.34; 95% CI, 0.19–0.63) were less likely to lose HBsAg. The median change in CD4 cell count during the observation period was 231 cells/mm3 in those with HBsAg loss vs 112 cells/mm3 in those with HBsAg persistence (P = .004). Conclusions HBsAg loss occurs in about 10% of those with chronic HBV infection. Being Hispanic, having AIDS at baseline, having an injection drug use history, and having HBeAg-negative status at baseline predicted the likelihood of HBsAg loss. Immune restoration may be a mechanism through which HBsAg loss occurs in HIV patients.
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Affiliation(s)
- Mamta K Jain
- UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA.,Parkland Health and Hospital System, Dallas, Texas, USA
| | - Karen J Vigil
- UT Southwestern Medical Center, Population and Data Science, Dallas, Texas, USA.,University of Texas Health Science Center, Department of Internal Medicine, Houston, Texas,USA
| | - Paul Parisot
- UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA
| | - Gabriella Go
- UT Southwestern Medical Center, Population and Data Science, Dallas, Texas, USA.,University of Texas Health Science Center, Department of Internal Medicine, Houston, Texas,USA
| | - Trung Vu
- University of Texas Health Science Center, Department of Internal Medicine, San Antonio, Texas, USA
| | - Xilong Li
- UT Southwestern Medical Center, Population and Data Science, Dallas, Texas, USA
| | - Laura Hansen
- UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA
| | - Barbara S Taylor
- University of Texas Health Science Center, Department of Internal Medicine, San Antonio, Texas, USA
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5
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Dezanet LNC, Maylin S, Gabassi A, Rougier H, Miailhes P, Lascoux-Combe C, Chas J, Girard PM, Delaugerre C, Lacombe K, Boyd A. Kinetics of Hepatitis B Core-Related Antigen and Anti-Hepatitis B Core Antibody and Their Association With Serological Response in Human Immunodeficiency Virus-Hepatitis B Coinfection. J Infect Dis 2021; 221:1826-1837. [PMID: 31960918 DOI: 10.1093/infdis/jiaa013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of the current study was to describe the kinetics of quantified hepatitis B core-related antigen (qHBcrAg) and quantified anti-hepatitis B core antibody (qAnti-HBc) during tenofovir (TDF) treatment and assess their ability to predict hepatitis B e antigen (HBeAg) seroclearance in patients coinfected with human immunodeficiency virus (HIV) and hepatitis B virus. METHODS Serum qHBcrAg, qAnti-HBc, and hepatitis B virus DNA were obtained at TDF initiation and every 6-12 months. The on-treatment kinetics of qHBcrAg (ΔqHBcrAg) and qAnti-HBc (ΔqAnti-HBc) were estimated using mixed-effect linear regression. Hazard ratios (HRs) assessing the association between markers and HBeAg seroclearance were calculated using proportional hazards regression, and the sensitivity (Se) and specificity (Sp) of marker levels in predicting HBeAg seroclearance were assessed using time-dependent receiving operating characteristic curves. RESULTS During a median of 4.6 years, the cumulative incidences of hepatitis B surface antigen and HBeAg seroclearance were 3.2% (n = 5 of 158) and 27.4% (n = 26 of 95), respectively. ΔqHBcrAg was biphasic in HBeAg-positive patients (-0.051 and -0.011 log10 U/mL/mo during ≤18 and >18 months, respectively) and monophasic in HBeAg-negative patients. ΔqAnti-HBc was monophasic regardless of HBeAg status. In HBeAg-positive patients, baseline qHBcrAg and qAnti-HBc levels were associated with HBeAg seroclearance (adjusted HR, 0.48/log10 U/mL [95% confidence interval, .33-.70] and unadjusted HR, 1.49/log10 Paul Ehrlich Institute units/mL [1.08-2.07], respectively). Cutoffs with the highest accuracy in predicting HBeAg seroclearance at 36 months were qHBcrAg <6.5 log10 U/mL at month 24 (Se, 1; Sp, 0.58) and baseline qAnti-HBc ≥4.1 log10 Paul Ehrlich Institute units/mL (Se, 0.42; Sp, 0.81). CONCLUSIONS In coinfected patients undergoing TDF, qHBcrAg/qAnti-HBc could be of use in monitoring HBeAg seroclearance.
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Affiliation(s)
- Lorenza N C Dezanet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Sarah Maylin
- APHP, Hôpital Saint-Louis, Laboratoire de Virologie, Paris, France, Université de Paris, INSERM U944, Institut de Recherche Saint-Louis, Paris, France
| | - Audrey Gabassi
- APHP, Hôpital Saint-Louis, Laboratoire de Virologie, Paris, France, Université de Paris, INSERM U944, Institut de Recherche Saint-Louis, Paris, France
| | - Hayette Rougier
- Institut de Médecine et d'Epidémiologie Appliquée, Paris, France
| | - Patrick Miailhes
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Service de Maladies Infectieuses, Lyon, France
| | | | - Julie Chas
- APHP, Hôpital Tenon, Service de Maladies Infectieuses, Paris, France
| | - Pierre-Marie Girard
- APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - Constance Delaugerre
- APHP, Hôpital Saint-Louis, Laboratoire de Virologie, Paris, France, Université de Paris, INSERM U944, Institut de Recherche Saint-Louis, Paris, France
| | - Karine Lacombe
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.,APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - Anders Boyd
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.,APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, Paris, France
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6
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Long-Term TDF-Inclusive ART and Progressive Rates of HBsAg Loss in HIV-HBV Coinfection-Lessons for Functional HBV Cure? J Acquir Immune Defic Syndr 2021; 84:527-533. [PMID: 32692112 DOI: 10.1097/qai.0000000000002386] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) is effective in suppressing HIV and hepatitis B virus (HBV) replication in HIV-HBV coinfection although HBV DNA can persist in some individuals on TDF-containing antiretroviral therapy (ART). We initiated a prospective longitudinal study to determine durability of HBV virological control and clinical outcomes after prolonged TDF-based ART in HIV-HBV coinfection. METHODS Ninety-two HIV-HBV coinfected participants on, or about to commence, TDF-containing ART from Australia (n = 41) and Thailand (n = 52) were enrolled. Participants were followed 6-monthly for 2 years, then annually to 5 years. Laboratory and clinical assessments and a serum sample were collected at each study visit. These analyses compare follow-up at 2 and 5 years. RESULTS 12.0% (95% confidence interval 6.8 to 20.2) of total study entry cohort (n = 92) or 15.3% (95% confidence interval: 8.8 to 25.3) of those with data to year 5 (n = 72) lost hepatitis B surface antigen (HBsAg). The only statistically significant association with HBsAg loss was lower study entry quantitative HBsAg. CD4 T-cell count increased by a median 245 cells/mm3 between the preTDF sample and 5 years of follow-up. By year 5, 98.5% of the cohort had undetectable HBV DNA (<15 IU/mL) and 91.4% had undetectable HIV RNA (<20 copies/mL). CONCLUSIONS HBsAg loss was high and ongoing over 5 years of follow-up in HIV-HBV coinfected individuals on TDF-containing ART and undetectable HBV was almost universal. Although the pattern of HBsAg loss temporarily parallels immune reconstitution, we could not identify predictive immune markers. The high rate of HBsAg loss in HIV-HBV coinfection may offer valuable insights into the search for a functional HBV cure.
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Zhou K, Terrault NA. Treatment of HCV, HDV, or HIV Coinfections. HEPATITIS B VIRUS AND LIVER DISEASE 2021:339-373. [DOI: 10.1007/978-981-16-3615-8_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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8
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Yang R, Gui X, Ke H, Xiong Y, Gao S. Long-term observation on hepatitis B surface antigen seroclearance in therapy experienced HIV/HBV co-infected Chinese. J Viral Hepat 2020; 27:127-134. [PMID: 31571343 DOI: 10.1111/jvh.13212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022]
Abstract
The aim of this retrospective study was to observe hepatitis B surface antigen (HBsAg) seroclearance and explore predictors of HBsAg loss in HIV/HBV-co-infected patients receiving long-term lamivudine or both tenofovir and lamivudine containing therapies. Quantification of HBsAg, hepatitis B e antigen and HBV DNA before and after initiation of HBV-active antiretroviral therapy in a total of 268 HIV/HBV-co-infected patients started treatment between 2005 and 2017 were performed. Over a median of 65.63 months of follow-up, 10 (3.7%) were observed HBsAg loss and the quantification of HBsAg in 7 (2.6%) patients were less than 50 IU/mL. With the prolongation of antiretroviral therapy duration time, the rates of HBsAg seroclearance tended to increase gradually, rising from 1.8% (3/163) during 2-4 years treatment to 29.4% (10/34) after antiretroviral therapy for up to 10 years. Lower baseline qHBsAg and HBV DNA levels and strong 12-month declines in qHBsAg were significantly associated with HBsAg seroclearance. The event of HBsAg seroclearance is uncommon among Chinese individuals with HIV/HBV co-infection who have been treated with anti-HBV containing antiretroviral therapy, and lifelong therapy for HBV is needed for HIV/HBV co-infected patients. Baseline qHBsAg and HBV DNA levels and qHBsAg decline rate were predictors for HBsAg seroclearance.
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Affiliation(s)
- Rongrong Yang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xien Gui
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hengning Ke
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yong Xiong
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shicheng Gao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
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9
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Jiang T, Su B, Song T, Zhu Z, Xia W, Dai L, Wang W, Zhang T, Wu H. Immunological Efficacy of Tenofovir Disproxil Fumarate-Containing Regimens in Patients With HIV-HBV Coinfection: A Systematic Review and Meta-Analysis. Front Pharmacol 2019; 10:1023. [PMID: 31572195 PMCID: PMC6752181 DOI: 10.3389/fphar.2019.01023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Hepatitis B virus (HBV) coinfection is common in HIV-positive patients. HIV infection modifies the natural course of HBV infection, leading to a faster progression of liver-related morbidity and mortality than is observed in HBV mono-infected patients. This systematic review and meta-analysis evaluates the current clinical evidence regarding the use of oral tenofovir disproxil fumarate (TDF)-based treatments in patients coinfected with HIV and HBV. Methods: We performed a comprehensive literature search in PubMed and Web of Science. Supplementary searches were conducted in Google Scholar and Clinicaltrials.gov. We conducted a random effects meta-analysis using the event rate (ER) to estimate the incidence of HBV seroconversion. A subgroup meta-analysis was performed to assess the moderate effects of demographic and disease-related variables on HBsAg loss. This review is registered in the PROSPERO database (CRD42018092379). Results: We included 11 studies in the review. The immunological effects of oral TDF-based Pre-exposure prophylaxis (PrEP) treatment in patients with HIV-HBV coinfection were 0.249 for HBeAg loss, 0.237 for HBeAg conversion, 0.073 for HBsAg loss, and 0.055 for HBsAg conversion. The factors associated with HBsAg loss were the baseline HBV viral load, participant’s location, and a history of exposure to lamivudine/emtricitabine (3TC/FTC) (all p < 0.05). A trend toward a negative relationship between the baseline CD4+ T-cell count and HBsAg loss was observed (p = 0.078). Conclusion: This systematic review and meta-analysis demonstrated that TDF-containing regimens are effective at stimulating HBeAg loss (24.9%), HBeAg conversion (23.7%), HBsAg loss (7.3%), and HBsAg conversion (5.5%) in HIV-HBV coinfected patients. The moderator analysis showed that HBV viral load, the location of participants, and prior exposure to 3TC/FTC are factors associated with HBsAg loss. Asian ethnicity, prior exposure to 3TC, and a nondetectable baseline HBV viral load are associated with lower odds of HBsAg loss. Well-designed prospective cohort studies and randomized controlled trials (RCTs) with large sample sizes are required for the investigation of potential predictors and biological markers associated with strategies for achieving HBV remission in patients with HIV-HBV coinfection, which is a matter of considerable importance to clinicians and those responsible for health policies.
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Affiliation(s)
- Taiyi Jiang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bin Su
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Ting Song
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Zhiqiang Zhu
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Xia
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Lili Dai
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
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10
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Sarkar J, Saha D, Bandyopadhyay B, Saha B, Chakravarty R, Guha SK. Lamivudine plus tenofovir versus lamivudine plus adefovir for the treatment of hepatitis B virus in HIV-coinfected patients, starting antiretroviral therapy. Indian J Med Microbiol 2018; 36:217-223. [PMID: 30084414 DOI: 10.4103/ijmm.ijmm_17_37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Combination of tenofovir disoproxil fumarate (TDF), lamivudine (3TC) and efavirenz (EFV) is preferred in the treatment of HIV/hepatitis B virus (HBV) coinfection. We postulated that a HBV active nucleoside reverse transcriptase (RT) inhibitor/nucleotide RT inhibitor backbone of adefovir dipivoxil (ADV) +3TC would be as effective as TDF +3TC for the Indian population. Objective ADV + 3TC could be an alternative option for these HIV/HBV coinfected individuals, preserving the dually active TDF + 3TC as second-line nucleoside backbone following failure of the first-line ART. Materials and Methods This randomised control trial (CTRI/2012/03/002471) was carried out at the ART Centre of Calcutta School of Tropical Medicine, India. Seventy-eight (39 on each arm) treatment-naïve HIV/HBV coinfected patients were randomised to receive either the combination of lamivudine + tenofovir + EFV or lamivudine + adefovir + zidovudine + EFV and followed up for 120 weeks. Results Median age of the study participants was 36 years (21-62), majority were male (61/78; 78.2%) and heterosexually (39/78; 50%) infected. Baseline characteristics were identical in both arms. There was no statistically significant difference in median aspartate aminotransferase (37 vs. 29.5 U/L), alanine aminotransferase (ALT) (36 vs. 34.5 U/L), ALT normalisation rate (80 vs. 70%), AST to platelet ratio index (0.45 vs. 0.33), CD4 count (508 vs. 427 cells/mm3), HBV DNA suppression (81.8 vs. 70%), hepatitis B e antigen loss (9 vs. 5%), hepatitis B surface antigen seroclearance rate (6.06 vs. 18.75%) and death (3 vs. 3) at 120 weeks between TDF (n = 33) and ADV (n = 32), respectively. Conclusions Adefovir plus lamivudine is an effective alternative of tenofovir plus lamivudine in long-term HBV treatment outcome in HIV/HBV coinfected patients.
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Affiliation(s)
- Jayeeta Sarkar
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Debraj Saha
- Department of Virology ICMR Virus Unit, ID and BG Hospital Campus, Kolkata, West Bengal, India
| | - Bhaswati Bandyopadhyay
- Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Bibhuti Saha
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Runu Chakravarty
- Department of Virology ICMR Virus Unit, ID and BG Hospital Campus, Kolkata, West Bengal, India
| | - Subhasish Kamal Guha
- Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
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11
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Boyd A, Moh R, Maylin S, Abdou Chekaraou M, Mahjoub N, Gabillard D, Anglaret X, Eholié SP, Delaugerre C, Danel C, Zoulim F, Lacombe K. Precore G1896A mutation is associated with reduced rates of HBsAg seroclearance in treated HIV hepatitis B virus co-infected patients from Western Africa. J Viral Hepat 2018; 25:1121-1131. [PMID: 29660214 DOI: 10.1111/jvh.12914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/20/2018] [Indexed: 12/22/2022]
Abstract
The nucleotide substitution G1896A on the precore (pc) region has been implicated in virological and serological responses during treatment in hepatitis B virus (HBV)-infected patients. Whether this mutation affects the therapeutic course of HIV-HBV co-infected patients, especially from Western Africa, is unknown. In this prospective cohort study, 86 antiretroviral (ARV)-naïve HIV-HBV co-infected patients from Côte d'Ivoire, initiating ARV-treatment containing lamivudine (n = 53) or tenofovir (n = 33), had available baseline pc sequences. Association of the pcG1896A mutation with time to undetectable HBV-DNA, hepatitis B "e" antigen (HBeAg) seroclearance (in HBeAg-positive patients), and hepatitis B surface antigen (HBsAg) seroclearance was evaluated using Cox proportional hazards regression. At ARV-initiation, median HBV-DNA was 6.04 log10 copies/mL (IQR = 3.70-7.93) with 97.7% harbouring HBV genotype E. Baseline pcG1896A mutation was identified in 51 (59.3%) patients, who were more commonly HBeAg-negative (P < .001) and had basal core promotor A1762T/G1764A mutations (P < .001). Patients were followed for a median 36 months (IQR = 24-36). Cumulative proportion of undetectable HBV-DNA was significantly higher in patients with baseline mutation (pcG1896A = 86.6% vs no pcG1896A = 66.9%, P = .04), but not after adjusting for baseline HBV-DNA levels and anti-HBV agent (P = .2). No difference in cumulative proportion of HBeAg seroclearance was observed between mutation groups (pcG1896A = 57.1% vs no pcG1896A = 54.3%, P = .7). Significantly higher cumulative proportion of HBsAg seroclearance was observed in patients without this mutation (pcG1896A = 0% vs no pcG1896A = 36.9%, P < .001), even after adjusting for baseline HBsAg quantification and anti-HBV agent (P < .001). In conclusion, lacking the pcG1896A mutation before ARV initiation appeared to increase HBsAg seroclearance rates during treatment. The therapeutic implications of this mutation need further exploration in this setting.
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Affiliation(s)
- A Boyd
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - R Moh
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire.,Department of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire.,Medical School, University Felix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - S Maylin
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France.,Université Paris-Diderot, Paris, France
| | | | - N Mahjoub
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - D Gabillard
- INSERM, U1219, Bordeaux, France.,University of Bordeaux, ISPED, Bordeaux, France
| | - X Anglaret
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire.,INSERM, U1219, Bordeaux, France.,University of Bordeaux, ISPED, Bordeaux, France
| | - S P Eholié
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire.,Department of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire.,Medical School, University Felix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - C Delaugerre
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France.,Université Paris-Diderot, Paris, France.,INSERM U941, Paris, France
| | - C Danel
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire.,INSERM, U1219, Bordeaux, France.,University of Bordeaux, ISPED, Bordeaux, France
| | - F Zoulim
- INSERM U1052- Cancer Research Center of Lyon (CRCL), Lyon, France.,University of Lyon, UMR_S1052, CRCL, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Lyon, France
| | - K Lacombe
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
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12
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Seck A, Ndiaye F, Maylin S, Ndiaye B, Simon F, Funk AL, Fontanet A, Takahashi K, Akbar SMF, Mishiro S, Bercion R, Vray M, Shimakawa Y. Poor Sensitivity of Commercial Rapid Diagnostic Tests for Hepatitis B e Antigen in Senegal, West Africa. Am J Trop Med Hyg 2018; 99:428-434. [PMID: 29869595 DOI: 10.4269/ajtmh.18-0116] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Limited access to nucleic acid tests for hepatitis B virus (HBV) DNA is a significant barrier to the effective management of chronic HBV infection in resource-poor countries. Alternatively, HBV e antigen (HBeAg) may accurately indicate high viral replication. We assessed the diagnostic performance of three commercially available rapid diagnostic tests (RDTs) for HBeAg (SD Bioline, Insight and OneStep) against a quantitative chemiluminescent immunoassay (CLIA, Architect). Using stored sera from adults with chronic HBV infection, we tested RDTs in three groups in Senegal (48 HBeAg-positive, 196 HBeAg-negative, and 117 cases with high HBV DNA (≥ 106 IU/mL)) and one group in France (17 HBeAg-positive East Asians). In Senegal, the sensitivity and specificity for HBeAg detection were 29.8% and 100% for SD Bioline, 31.1% and 100% for Insight, and 42.5% and 98.4% for OneStep, respectively. The lower limits of detection of these RDTs were very high (> 2.5 log10 Paul Ehrlich Institut units/mL). Their low sensitivity was also confirmed in HBeAg-positive Asian samples (35.3-52.9%). The prevalence of HBeAg in highly viremic (≥ 106 IU/mL) Senegalese patients was low: 58.1% using CLIA and 24.5-37.5% using RDTs. Hepatitis B e antigen prevalence was similarly low in a subgroup of 28 Senegalese women of childbearing age with a high viral load (≥ 106 IU/mL). Approximately, half of highly viremic adults do not carry HBeAg in Africa, and HBeAg RDTs had remarkably poor analytical and diagnostic sensitivity. This implies that HBeAg-based antenatal screening, particularly if using the currently available HBeAg RDTs, may overlook most pregnant women at high risk of mother-to-child transmission in Africa.
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Affiliation(s)
- Abdoulaye Seck
- Faculté de Médecine, Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal.,Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, Dakar, Sénégal
| | | | - Sarah Maylin
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Babacar Ndiaye
- Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, Dakar, Sénégal
| | - François Simon
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Anna L Funk
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Arnaud Fontanet
- Unité PACRI, Conservatoire National des Arts et Métiers, Paris, France.,Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Kazuaki Takahashi
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | | | - Shunji Mishiro
- Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan
| | - Raymond Bercion
- Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, Dakar, Sénégal
| | - Muriel Vray
- Unité d'Épidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Sénégal.,Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
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13
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Coffin CS, Terrault NA. Treatment of HCV, HDV, or HIV Coinfection. HEPATITIS B VIRUS AND LIVER DISEASE 2018:239-262. [DOI: 10.1007/978-981-10-4843-2_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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14
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Singh KP, Crane M, Audsley J, Avihingsanon A, Sasadeusz J, Lewin SR. HIV-hepatitis B virus coinfection: epidemiology, pathogenesis, and treatment. AIDS 2017; 31:2035-2052. [PMID: 28692539 PMCID: PMC5661989 DOI: 10.1097/qad.0000000000001574] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
: HIV infection has a significant impact on the natural history of chronic hepatitis B virus (HBV) infection, with increased levels of HBV DNA, accelerated progression of liver disease and increased liver-associated mortality compared with HBV monoinfection. Widespread uptake and early initiation of HBV-active antiretroviral therapy has substantially improved the natural history of HIV-HBV coinfection but the prevalence of liver disease remains elevated in this population. In this paper, we review recent studies examining the natural history and pathogenesis of liver disease and seroconversion in HIV-HBV coinfection in the era of HBV-active antiretroviral therapy and the effects of HIV directly on liver disease. We also review novel therapeutics for the management of HBV with a particular emphasis on clinical strategies being developed for an HBV cure and an HIV cure and their impact on HIV-HBV coinfected individuals.
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Affiliation(s)
- Kasha P Singh
- aThe Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital bVictorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity cDepartment of Infectious Diseases, Alfred Hospital and Monash University, Melbourne Australia dThai Red Cross AIDS Research Center and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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15
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Aurpibul L, Lumbiganon P, Hansudewechakul R, Kanjanavanit S, Bunupuradah T, Kosalaraksa P, Taeprasert P, Puthanakit T. Response to Tenofovir Among Lamivudine-experienced Hepatitis B and HIV-coinfected Adolescents. Pediatr Infect Dis J 2017; 36:401-404. [PMID: 28005687 PMCID: PMC5348266 DOI: 10.1097/inf.0000000000001491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We determined hepatitis B virus (HBV) suppression rates among 18 lamivudine (3TC)-experienced HBV-human immunodeficiency virus-coinfected adolescents after treatment with tenofovir disoproxil fumurate (TDF). At TDF initiation, their median age was 17.6 years, and duration of 3TC exposure was 7.3 years. Eleven patients (61%) achieved HBV DNA <60 IU/mL after 48 weeks on TDF and 3TC which was similar to adult studies, although hepatitis B surface antigen loss or hepatitis B envelope antigen seroconversion did not occur.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Pagakrong Lumbiganon
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Torsak Bunupuradah
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), the Thai Red Cross AIDS Research, Bangkok, Thailand
| | - Pope Kosalaraksa
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Thanyawee Puthanakit
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), the Thai Red Cross AIDS Research, Bangkok, Thailand,Department of pediatrics, Faculty of Medicine, and Research Unit in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
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16
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Toscano ALDCC, Corrêa MCM. Evolution of hepatitis B serological markers in HIV coinfected patients: a case study. Rev Saude Publica 2017; 51:24. [PMID: 28380208 PMCID: PMC5479400 DOI: 10.1590/s1518-8787.2017051006693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/17/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To describe the evolution of serological markers among HIV and hepatitis B coinfected patients, with emphasis on evaluating the reactivation or seroreversion of these markers. METHODS The study population consisted of patients met in an AIDS Outpatient Clinic in São Paulo State, Brazil. We included in the analysis all HIV-infected and who underwent at least two positive hepatitis B surface antigen serological testing during clinical follow up, with tests taken six months apart. Patients were tested with commercial kits available for hepatitis B serological markers by microparticle enzyme immunoassay. Clinical variables were collected: age, sex, CD4+ T-cell count, HIV viral load, alanine aminotransferase level, exposure to antiretroviral drugs including lamivudine and/or tenofovir. RESULTS Among 2,242 HIV positive patients, we identified 105 (4.7%) patients with chronic hepatitis B. Follow up time for these patients varied from six months to 20.5 years. All patients underwent antiretroviral therapy during follow-up. Among patients with chronic hepatitis B, 58% were hepatitis B "e" antigen positive at the first assessment. Clearance of hepatitis B surface antigen occurred in 15% (16/105) of patients with chronic hepatitis B, and 50% (8/16) of these patients presented subsequent reactivation or seroreversion of hepatitis B surface antigen. Among hepatitis B "e" antigen positive patients, 57% (35/61) presented clearance of this serologic marker. During clinical follow up, 28.5% (10/35) of those who initially cleared hepatitis B "e" antigen presented seroreversion or reactivation of this marker. CONCLUSIONS Among HIV coinfected patients under antiretroviral therapy, changes of HBV serological markers were frequently observed. These results suggest that frequent monitoring of these serum markers should be recommended.
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Affiliation(s)
- Ana Luiza de Castro Conde Toscano
- Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil.,Departamento de Doenças Infecciosas. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Maria Cássia Mendes Corrêa
- Departamento de Doenças Infecciosas. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo. Laboratório de Investigação Médica 52. São Paulo, SP, Brasil
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17
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Béguelin C, Friolet N, Moradpour D, Sahli R, Suter-Riniker F, Lüthi A, Cavassini M, Günthard HF, Battegay M, Bernasconi E, Schmid P, Calmy A, Atkinson A, Rauch A, Wandeler G. Impact of Tenofovir on Hepatitis Delta Virus Replication in the Swiss Human Immunodeficiency Virus Cohort Study. Clin Infect Dis 2017; 64:1275-1278. [DOI: 10.1093/cid/cix125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/03/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Charles Béguelin
- Department of Infectious Diseases, Bern University Hospital, University of Bern,
| | - Nicole Friolet
- Department of Infectious Diseases, Bern University Hospital, University of Bern,
| | | | - Roland Sahli
- Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne,
| | | | - Alexander Lüthi
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern,
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne, University of Lausanne,
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, and
- Institute of Medical Virology, University of Zurich,
| | - Manuel Battegay
- Department of Infectious Diseases & Hospital Hygiene, University Hospital Basel,
| | | | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen,
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, and
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern,
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern,
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern,
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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18
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Cornberg M, Wong VWS, Locarnini S, Brunetto M, Janssen HLA, Chan HLY. The role of quantitative hepatitis B surface antigen revisited. J Hepatol 2017; 66:398-411. [PMID: 27575311 DOI: 10.1016/j.jhep.2016.08.009] [Citation(s) in RCA: 259] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/09/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023]
Abstract
In the past 10years, there has been a lot of enthusiasm surrounding the use of serum hepatitis B surface antigen (HBsAg) quantification to predict disease activity and monitor treatment response in chronic hepatitis B. The measurement of HBsAg levels have been standardized in IU/ml, and nowadays it is almost a mandatory measurement due to the development of new antiviral treatments aiming at HBsAg seroclearance, i.e., functional cure of hepatitis B. Recently, there has been an improved understanding of the molecular virology of HBsAg, and particularly the relative roles of covalently closed circular DNA and integrated hepatitis B virus (HBV) DNA. This has shed new light on the interpretation of HBsAg levels in different phases of chronic hepatitis B. HBsAg level can assist the differentiation of immune tolerance and immune clearance in hepatitis B e antigen (HBeAg)-positive patients, and it can predict inactive disease and spontaneous HBsAg seroclearance in HBeAg-negative patients. The determination of HBsAg level is pivotal to individualize pegylated interferon (PegIFN) treatment; it is the key investigation to decide early termination of PegIFN among non-responders. Among patients treated by nucleos(t)ide analogues, responders tend to have dramatic reduction of HBsAg to low levels, which may be followed by HBsAg seroclearance. With newer data on combination treatment of PegIFN and nucleos(t)ide analogues as well as emerging new antiviral agents, HBsAg quantification is expected to become increasingly important to monitor and guide antiviral therapy for chronic hepatitis B.
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Affiliation(s)
- Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Institute of Digestive Disease and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Stephen Locarnini
- Victorian Infectious Diseases Reference Laboratory (VIDRL), Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Maurizia Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Italy
| | - Harry L A Janssen
- Toronto Center for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
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19
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Boyd A, Maylin S, Moh R, Mahjoub N, Gabillard D, Eholié SP, Danel C, Anglaret X, Zoulim F, Girard PM, Delaugerre C, Lacombefor K. Hepatitis B surface antigen quantification as a predictor of seroclearance during treatment in HIV-hepatitis B virus coinfected patients from Sub-Saharan Africa. J Gastroenterol Hepatol 2016; 31:634-44. [PMID: 26313291 DOI: 10.1111/jgh.13156] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM In Sub-Saharan Africa, seroclearance of hepatitis B surface antigen (HBsAg) and hepatitis B "e" antigen (HBeAg), including their quantifiable markers, have rarely been evaluated during long-term antiviral treatment among patients coinfected with HIV and hepatitis B virus (HBV). METHODS In this prospective cohort study from two randomized-control trials in Côte d'Ivoire, 161 antiretroviral-naïve HIV-HBV coinfected patients starting lamivudine (n = 76) or tenofovir/emtricitabine (n = 85) containing antiretroviral therapy were included. HBV DNA was quantified using an in-house assay (detection limit = 12 copies/mL) and HBsAg quantification (qHBsAg) using the Elecsys assay. RESULTS Overall, 33 (20.5%) patients were HBeAg positive, 121 (75.2%) had detectable HBV DNA, and 92/93 (98.9%) harbored HBV genotype E. Median treatment duration was 35.5 months (interquartile range: 24.3-36.4). Among HBeAg-positive patients, cumulative proportion with HBeAg seroclearance was 46.3% (n = 14). Overall, cumulative proportion of HBsAg seroclearance was 6.6% (n = 10). Lower baseline qHBsAg levels and strong 12-month declines in qHBsAg were significantly associated with HBsAg seroclearance for both HBeAg-negative and HBeAg-positive patients. When taken at certain levels, these determinants provided moderate sensitivity (Se) and specificity (Sp) in predicting HBsAg seroclearance at month 36 (≤ 1000 IU/mL at baseline, Se = 0.80, Sp = 0.80; ≥ 1.0 log10 IU/mL drop at month 12, Se = 0.57, Sp = 1.00). Instead, qHBsAg levels ≤ 100 or ≤ 10 IU/mL at month 12 were optimal (both Se = 0.90 and Sp = 1.00). Detectable HBV-DNA provided fairly high Se and Sp when evaluated at baseline (Se = 1.00, Sp = 0.80), but not at month 12 (Se = 0.80, Sp = 0.40). CONCLUSIONS HBsAg seroclearance rates are not common in patients from Sub-Saharan Africa treated with anti-HBV containing antiretroviral therapy. qHBsAg levels at 12 months of treatment may accurately predict HBsAg seroclearance.
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Affiliation(s)
- Anders Boyd
- INSERM, UMR_S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Sarah Maylin
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France.,INSERM U941, Paris, France.,Université Paris-Diderot, Paris, France
| | - Raoul Moh
- Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Ivory Coast
| | - Nadia Mahjoub
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France.,INSERM U941, Paris, France
| | - Delphine Gabillard
- Epidémiologie-Biostatistique, INSERM, U897.,ISPED, University of Bordeaux, Bordeaux, France
| | - Serge Paul Eholié
- Medical School, University Felix Houphouet Boigny, Abidjan, Côte d'Ivoire.,Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Ivory Coast.,Department of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Ivory Coast
| | - Christine Danel
- Epidémiologie-Biostatistique, INSERM, U897.,ISPED, University of Bordeaux, Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Ivory Coast
| | - Xavier Anglaret
- Epidémiologie-Biostatistique, INSERM, U897.,ISPED, University of Bordeaux, Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Ivory Coast
| | - Fabien Zoulim
- Centre de Recherche sur le Cancer de Lyon, Equipes 15 et 16, INSERM, Unité 1052, Lyon, France
| | - Pierre-Marie Girard
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, Paris, France.,Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1136, Paris, France
| | - Constance Delaugerre
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France.,INSERM U941, Paris, France.,Université Paris-Diderot, Paris, France
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20
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Piroth L, Pol S, Miailhes P, Lacombe K, Lopes A, Fillion A, Loustaud-Ratti V, Borsa-Lebas F, Salmon D, Rosenthal E, Carrat F, Cacoub P. Therapeutic management and evolution of chronic hepatitis B: does HIV still have an impact? The EPIB 2012 study. Liver Int 2015; 35:1950-1958. [PMID: 25559645 DOI: 10.1111/liv.12777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/22/2014] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS To compare the management of chronic hepatitis B (CHB) and its evolution over time in currently followed HIV-positive and HIV-negative patients. METHODS A total of 709 consecutive patients with past or present positive HBs antigenemia seen in October 2012 in 19 French participating centres were included. The data were retrospectively collected from the first visit onwards through standardized questionnaires. RESULTS Chronic hepatitis B was less often assessed in the 299 HIV-positive patients, who were older, more likely to be male, excessive alcohol drinkers and HBe antigen-, HCV- and HDV-positive. They were also followed up for a longer time (11.3 +/-8.8 vs. 8.6 +/-6.9 years, P < 10(-3) ) and were more frequently treated for HBV (95.3% vs. 56.8%, P < 10(-3) ). HBV was undetectable at the last visit in 80.8% of HIV-positive vs. 55.1% of HIV-negative patients (P < 10(-3) ). In multivariate analyses, undetectable HBV was significantly associated with older age, lower baseline HBV DNA, longer HBV therapy and no previous lamivudine monotherapy, but not with HIV. Cirrhosis was associated with age, male gender, Asian origin, alcoholism, HCV, HDV, but not with HIV infection. Hepatocellular carcinoma, less frequently observed in HIV-positive patients (0.7% vs. 4.7%, P = 0.002), was positively associated with age, male gender, cirrhosis and negatively associated with HIV infection (OR 0.15, 95%CI 0.03-0.67, P = 0.01). CONCLUSIONS Although the assessment of CHB still has to be improved in HIV-positive patients, the negative impact of HIV on the virological, histological and clinical evolution of CHB seems to be disappearing, probably because of the immunovirological impact of HAART and the more frequent and longer use of HBV therapy.
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Affiliation(s)
- Lionel Piroth
- Infectious Diseases Department, CHU and UMR 1347, University of Burgundy, Dijon, France
| | - Stanislas Pol
- Institut Pasteur, INSERM UMS 20, Service d'Hépatologie, Université Paris Descartes and APHP, Paris, France
| | - Patrick Miailhes
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service des Maladies Infectieuses et Tropicales and INSERM U1052, Lyon, France
| | - Karine Lacombe
- Infectious Diseases Department, CHU and UMR-S707, University Pierre and Marie Curie, Paris, France
| | - Amanda Lopes
- Université Paris Diderot and AP-HP Service de Medecine Interne A, Paris, France
| | - Aurélie Fillion
- Infectious Diseases Department, CHU and UMR 1347, University of Burgundy, Dijon, France
| | - Véronique Loustaud-Ratti
- Federation of Hepatology CHU Limoges and Inserm UMR 1092, University of Limoges, Limoges, France
| | | | - Dominique Salmon
- Cochin Hospital, Infectious Pathology unit, Paris Descartes University, Infectious Pathology unit, Paris, France
| | - Eric Rosenthal
- Department of internal medicine, CHU De Nice and University of Nice Sophia Antipolis, Nice, France
| | - Fabrice Carrat
- UPMC Université Paris 06, UMR-S707, INSERM U-707, AP-HP, Public Health Department, Paris, France
| | - Patrice Cacoub
- Departement Hospitalo Universitaire I2B, UPMC Université Paris 06, Paris, France
- UMR 7211, INSERM, UMR_S 959, Paris, France
- CNRS, UMR 7211, Paris, France
- Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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21
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Boyd A, Maylin S, Gozlan J, Delaugerre C, Simon F, Girard PM, Lacombe K. Use of hepatitis B surface and "e" antigen quantification during extensive treatment with tenofovir in patients co-infected with HIV-HBV. Liver Int 2015; 35:795-804. [PMID: 24606220 DOI: 10.1111/liv.12521] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 03/02/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS In patients infected with hepatitis B virus (HBV) and HIV, hepatitis B 'e' antigen (qHBeAg) and hepatitis B surface antigen quantification (qHBsAg) may be used to predict short-term HBeAg and HBsAg loss, respectively. To determine if these quantifiable markers also provide accurate prediction of antigen loss during long-term, extensive tenofovir (TDF) treatment and to further establish qHBsAg profiles associated with HBsAg seroconversion. METHODS Prospective study of 111 co-infected, antiretroviral-experienced patients undergoing a TDF-containing regimen for >12 months. HBV-DNA viral load, qHBeAg [Paul Ehrlich Institute Units (PEIU)/ml] and qHBsAg were quantified at baseline and every 6-12 months. Sensitivity (Se) and specificity (Sp) of qHBeAg criteria were calculated using a time-dependent receiver operator characteristic curve, and qHBsAg profiles were developed using a group-based trajectory model. RESULTS After a median 74.2 months (IQR: 33.1-94.7) of TDF treatment, four patients had HBsAg seroconversion. Among the 78 (70.3%) HBeAg-positive patients, cumulative proportion with HBeAg loss was 42.0% (n = 23) at month 96. Baseline qHBeAg ≤100 PEIU/ml was the only significant factor for HBeAg loss (adjusted-HR = 2.36, 95% CI: 1.02-5.46) in multivariable analysis. In terms of predicting HBeAg-loss until month 96, qHBeAg ≤10 PEIU/ml was more accurate when evaluated at month 24 (Se = 0.73, Sp = 0.80) than month 12 (Se = 0.48, Sp = 0.90). All four patients with HBsAg seroconversion had profiles with large decreases in qHBsAg (>2 log10 IU/ml), not necessarily occurring during the first 12 months, which was infrequent in patients without seroconversion (8.4%, P < 0.001). CONCLUSIONS Quantifying hepatitis 'e' antigen during the first 2 years of TDF treatment is a practical tool in predicting long-term HBeAg loss. Non time-specific declines in qHBsAg may be a useful indicator of HBsAg seroconversion.
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Affiliation(s)
- Anders Boyd
- INSERM UMR_S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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22
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Abstract
BACKGROUND Hepatitis delta virus (HDV) produces the most severe form of chronic viral hepatitis. We explored whether prolonged tenofovir exposure might be beneficial on hepatitis delta in HIV-infected patients. METHODS All HIV-infected patients with hepatitis delta followed at our institution since year 2000 were retrospectively examined. Serum HBV-DNA and HDV-RNA were quantified using commercial assays. Liver fibrosis was measured using elastometry. RESULTS A total of 19 HIV/delta patients were identified. All were viremic for HDV and 11 for HBV. After a median tenofovir exposure of 58 months, all had undetectable HBV-DNA and 10 (53%) had undetectable HDV-RNA. The median drop in HDV-RNA in the remaining nine HDV viremic patients at the end of follow-up was 2.4 log copies/ml. A reduction above 30% in liver stiffness occurred in six out 10 (60%) patients who achieved undetectable HDV-RNA, whereas hepatic stiffness did not change in the remaining HDV viremic patients (P = 0.03). Serum HBsAg concentrations did not decline significantly, although HBsAg seroclearance occurred in three patients, all of whom became negative for HDV-RNA. CONCLUSION Long-term exposure to tenofovir significantly reduced serum HDV-RNA apart from completely suppressing HBV-DNA in HIV-infected patients with hepatitis delta. This virological benefit is accompanied by significant improvements in liver fibrosis.
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23
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Miailhes P, Maynard-Muet M, Lebossé F, Carrat F, Bouix C, Lascoux-Combe C, Sogni P, Rey D, Barthe Y, Pol S, Cacoub P, Zoulim F, Piroth L. Role of a 48-week pegylated interferon therapy in hepatitis B e antigen positive HIV-co-infected patients on cART including tenofovir: EMVIPEG study. J Hepatol 2014; 61:761-9. [PMID: 24882048 DOI: 10.1016/j.jhep.2014.05.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/04/2014] [Accepted: 05/21/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS In hepatitis B e antigen (HBeAg) positive-HIV co-infected patients treated with combined antiretroviral therapy (cART), including tenofovir disoproxil fumarate (TDF), the rate of HBe seroconversion remains low. Whether adding pegylated interferon alfa (PegIFN) could increase the likelihood of HBeAg loss and HBe seroconversion has not been assessed. METHODS A 48-week PegIFN therapy was added to HBeAg positive-HIV co-infected patients on TDF and emtricitabine, or lamivudine for at least 6 months. The primary endpoint was HBV sustained response: HBe seroconversion with undetectable HBV DNA levels 24 weeks after completing PegIFN therapy (W72). RESULTS Fifty-one patients (49 men, median age 46 years, range: 32-65), were included. Median duration of HIV, HBV infections and TDF therapy was 10.3 (0.6-22), 9.8 (0.5-16), and 3.3 (0.5-6.8)years, respectively. Median baseline CD4 count was 506 (175-1316)/mm(3). HIV viral load was <50 copies/ml in 49 (96%) patients. Nine (18%) patients stopped PegIFN prematurely. Ten (20%) patients experienced HBeAg loss at W72 and four (8%) patients had a HBV sustained response. No HBs seroconversion was observed. Only patients with more than 350 CD4/mm(3) at baseline achieved HBe loss. HBeAg level >10 PEIU/ml at W12 or a quantitative HBsAg decline <0.5 log IU/ml at W24 had 100% and 84% negative predictive values for response, respectively. CONCLUSIONS 48-week PegIFN additional therapy to cART including TDF did not significantly increase the HBe seroconversion rate, despite an HBeAg loss in 20% of the patients. HBe and HBs kinetics may nevertheless be of help in tailoring and optimising this strategy.
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Affiliation(s)
- Patrick Miailhes
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, INSERM U1052, Lyon, France.
| | - Marianne Maynard-Muet
- Service d'Hépatologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, INSERM U1052, Lyon, France
| | - Fanny Lebossé
- Service d'Hépatologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, INSERM U1052, Lyon, France
| | - Fabrice Carrat
- UMRS-707, Université Paris 6 et INSERM, Santé Publique, APHP, Paris, France
| | - Cécile Bouix
- Service d'Hépatologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, INSERM U1052, Lyon, France
| | - Caroline Lascoux-Combe
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, APHP, Paris, France
| | - Philippe Sogni
- Université Paris Descartes, Inserm U1016, Unité d'Hépatologie, APHP, Hôpital Cochin, Paris, France
| | - David Rey
- Center for HIV infection Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yoann Barthe
- UMRS-707, Université Paris 6 et INSERM, Santé Publique, APHP, Paris, France
| | - Stanislas Pol
- Université Paris Descartes, Inserm U1016, Unité d'Hépatologie, APHP, Hôpital Cochin, Paris, France
| | - Patrice Cacoub
- Hôpital de La Pitié-Salpêtrière, Service de Médecine Interne, CNRS UMR 7087, Univ Pierre et Marie Curie, Paris, France
| | - Fabien Zoulim
- Service d'Hépatologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, INSERM U1052, Lyon, France
| | - Lionel Piroth
- Service des Maladies Infectieuses, Hôpital du bocage, Université de Bourgogne, Dijon, France
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24
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Boyd A, Gozlan J, Maylin S, Delaugerre C, Peytavin G, Girard PM, Zoulim F, Lacombe K. Persistent viremia in human immunodeficiency virus/hepatitis B coinfected patients undergoing long-term tenofovir: virological and clinical implications. Hepatology 2014; 60:497-507. [PMID: 24752996 DOI: 10.1002/hep.27182] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/15/2014] [Indexed: 12/11/2022]
Abstract
UNLABELLED Tenofovir (TDF) is considered the ideal treatment for patients coinfected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV). However, certain coinfected patients exhibit incomplete viral suppression, with persistent, and sometimes transient, bouts of HBV replication. The reasons for this, including clinical effect, are unclear. A total of 111 HIV-HBV-infected patients undergoing TDF-containing antiretroviral therapy were prospectively followed. Serum HBV-DNA viral load, hepatitis surface (HBsAg) and e antigen (HBeAg) status were obtained at baseline and every 6-12 months. Amino acid (aa) changes on the polymerase gene were assessed using direct sequencing after nested polymerase chain reaction in patients with persistent viremia (PV). After a median of 74.7 months (interquartile range: 33.4-94.7), virological response (VR; <60 IU/mL) occurred in 96 of 111 (86.5%) patients. Of these, 86 of 96 (89.6%) remained completely undetectable during follow-up (stabilized VR). The remaining 10 of 96 (10.4%) patients had a transient blip of detectable HBV-DNA (transient PV), during which time 9 of 9 (100%) with available samples had detectable plasma TDF. Low-level PV (LL-PV; 61-2,000 IU/mL) was observed in 11 of 111 (9.9%) patients, the majority of which had detectable plasma TDF (8 of 9; 88.9%). High-level PV (>2,000 IU/mL) was rare (4 of 111; 3.6%) and was associated with nonadherence. At TDF initiation, patients with stabilized VR had significantly higher nadir CD4(+) count, compared to those with transient PV (P = 0.006) or LL-PV (P = 0.04). No consistent aa changes, other than those associated with lamivudine resistance, were observed in patients with persistent viremia. Importantly, HBeAg loss, HBeAg seroconversion, and HBsAg loss only occurred in patients with stabilized VR. Two patients with stabilized VR developed hepatocellular carcinoma and 2 with LL PV died, 1 of a liver-related cause. CONCLUSION Suboptimal HBV control during TDF treatment has a negative effect on serological outcomes, but not necessarily clinical events. Immunoregulation may provide more insight into this phenomenon.
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Affiliation(s)
- Anders Boyd
- INSERM UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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25
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Strassl R, Reiberger T, Honsig C, Payer BA, Mandorfer M, Grabmeier-Pfistershammer K, Rieger A, Kundi M, Grundtner P, Peck-Radosavljevic M, Popow-Kraupp T. Viral determinants predicting hepatitis B surface antigen (HBsAg) seroclearance in HIV-/HBV-coinfected patients. J Viral Hepat 2014; 21:508-16. [PMID: 24112778 DOI: 10.1111/jvh.12175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 07/01/2013] [Indexed: 01/03/2023]
Abstract
The aim of this retrospective study was the identification of clinically useful viral determinants for the prediction of hepatitis B surface antigen (HBsAg) seroclearance and sustained virological response in hepatitis B virus/human immunodeficiency virus (HBV-/HIV)-coinfected patients receiving HBV-active combined antiretroviral therapy (cART). Quantification of HBsAg, HBeAg and HBV DNA before and after initiation of HBV-active cART in a cohort of 59 HIV-/HBV-coinfected patients was performed. Calculations of receiver operating characteristics (ROC) and Kaplan-Meier analysis were used for the identification of predictors of HBsAg seroclearance for HBeAg-positive [HBeAg(+); n = 36] and HBeAg-negative [HBeAg(-);n = 23] patients. HBeAg(+) patients with an HBsAg on-treatment decline ≥ 1 log IU/mL per year achieved higher HBsAg loss rates (P = 0.0294), whereas the quantification of HBeAg had no predictive value for HBsAg seroclearance. Among HBeAg(-) patients, a pretreatment baseline cut-off level of HBsAg ≤ 100 IU/mL was highly predictive for HBsAg seroclearance. No significant influence of the HBV genotype on HBsAg seroclearance was observed among the entire cohort. Quantitative determination of HBsAg provides a clinically useful viral parameter for the prediction of HBsAg seroclearance both in HBeAg(+) and HBeAg(-) HIV-/HBV-coinfected patients receiving HBV-active cART.
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Affiliation(s)
- R Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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26
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Factors associated with delayed hepatitis B viral suppression on tenofovir among patients coinfected with HBV-HIV in the CNICS cohort. J Acquir Immune Defic Syndr 2014; 66:96-101. [PMID: 24500175 DOI: 10.1097/qai.0000000000000126] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite widespread use in HIV and hepatitis B virus (HBV) infection, the effectiveness of tenofovir (TDF) has not been studied extensively outside of small cohorts of coinfected patients with HBV-HIV. We examined the effect of prior lamivudine (3TC) treatment and other factors on HBV DNA suppression with TDF in a multisite clinical cohort of coinfected patients. METHODS We studied all patients enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems cohort from 1996 to 2011 who had chronic HBV and HIV infection, initiated a TDF-based regimen continued for ≥ 3 months and had on-treatment HBV DNA measurements. We used Kaplan-Meier curves and Cox-proportional hazards to estimate time to suppression (HBV DNA level <200 IU/mL or <1000 copies/mL) by selected covariates. RESULTS Among 397 coinfected patients on TDF, 91% were also on emtricitabine or 3TC concurrently, 92% of those tested were hepatitis B e antigen positive, 196 (49%) had prior 3TC exposure; 192 (48%) achieved HBV DNA suppression over a median of 28 months (interquartile range: 13-71). Median time to HBV DNA suppression was 17 months for those who were 3TC-naive and 50 months for those who were 3TC exposed. After controlling for other factors, prior 3TC exposure, baseline HBV DNA level >10,000 IU/mL, and lower nadir CD4 count were independently associated with decreased likelihood of HBV DNA suppression on TDF. CONCLUSIONS These results emphasize the role of prior 3TC exposure and immune response on delayed HBV suppression on TDF.
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27
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Wang H, Yan R, Zhou Y, Wang MS, Ruo GQ, Cheng MJ. Comparison of hepatitis B surface antigen and e antigen in predicting liver histology in hepatitis B e antigen-positive chronic hepatitis B patients. Hepatol Int 2014; 8:216-223. [DOI: 10.1007/s12072-013-9502-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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28
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Hafkin JS, Osborn MK, Localio AR, Amorosa VK, Kostman JR, Stern JJ, De La Torre P, Mounzer K, Frank I, Gross R, Chang KM, Lo Re V. Incidence and risk factors for incomplete HBV DNA suppression in HIV/HBV-co-infected patients initiating tenofovir-based therapy. J Viral Hepat 2014; 21:288-96. [PMID: 24597697 PMCID: PMC3950944 DOI: 10.1111/jvh.12142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/23/2013] [Indexed: 12/22/2022]
Abstract
Suppression of hepatitis B virus (HBV)-DNA to undetectable levels is an important goal for HIV/HBV-co-infected patients receiving anti-HBV-active antiretroviral therapy (ART), and current guidelines recommend that this outcome should be reached by 1 year of treatment. However, the proportion of patients that fail to achieve an undetectable HBV DNA at this time point and its determinants remain unknown in clinical practice. The objective of this study was to determine the incidence and risk factors for incomplete HBV suppression following 1 year of tenofovir-based ART. We performed a cohort study among tenofovir-treated HIV/HBV-co-infected patients. Patients had HBV viraemia, initiated tenofovir-based ART and had HBV DNA measured at 1 year of therapy. The primary outcome was incomplete HBV suppression (HBV DNA ≥2.6 log IU/mL) at 1 year. Logistic regression determined odds ratio (ORs) of incomplete HBV suppression for risk factors of interest. Among 133 patients, 54% (95% CI, 46-63%) had incomplete HBV suppression at 1 year. Incomplete suppression was associated with higher baseline HBV DNA (OR, 1.46 per log IU/mL increase; 95% CI, 1.1-1.94) and detectable HIV viraemia at 1 year (OR, 2.52; 95% CI, 1.19-5.32). Among 66 patients with suppressed HIV RNA at 1 year, 28 (42%) failed to achieve an undetectable HBV DNA. Failure to suppress HBV DNA by 1 year occurred in a sizeable proportion of tenofovir-treated HIV/HBV-co-infected patients. Higher HBV DNA and detectable HIV viraemia were risk factors for incomplete HBV suppression.
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Affiliation(s)
- Jeffrey S. Hafkin
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Medicine Service, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Melissa K. Osborn
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - A. Russell Localio
- Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Valerianna K. Amorosa
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Medicine Service, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Jay R. Kostman
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Medicine, Penn Presbyterian Medical Center, Philadelphia, PA
| | - John J. Stern
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Medicine, Pennsylvania Hospital, Philadelphia, PA
| | - Pola De La Torre
- Division of Infectious Diseases, Department of Medicine, Cooper University Hospital, Camden, NJ
| | - Karam Mounzer
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Jonathan Lax Treatment Center, Philadelphia Field Initiating Group for HIV Trials, Philadelphia, PA
| | - Ian Frank
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Medicine Service, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Kyong-Mi Chang
- Medicine Service, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA,Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Medicine Service, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA,Department of Medicine, Penn Presbyterian Medical Center, Philadelphia, PA
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29
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Boyd A, Miailhes P, Brichler S, Scholtès C, Maylin S, Delaugerre C, Chevallier-Queyron P, Gordien E, Girard PM, Lacombe K. Effect of tenofovir with and without interferon on hepatitis D virus replication in HIV-hepatitis B virus-hepatitis D virus-infected patients. AIDS Res Hum Retroviruses 2013; 29:1535-40. [PMID: 23972039 DOI: 10.1089/aid.2013.0008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The effect of tenofovir (TDF) alone or in combination with interferon on hepatitis D virus (HDV) replication is poorly characterized in patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and HDV. We analyzed triinfected patients undergoing treatment with either TDF alone (n=13) or including interferon (IFN) at some point during TDF therapy (TDF+IFN, n=4). Linear mixed-effect models were used to estimate the mean change from baseline of HDV-RNA and hepatitis surface antigen (HBsAg) levels during treatment. Patients were followed for a median 31.6 (25-75%-tile: 15.0-47.4) months. In the TDF+IFN group, three initiated IFN-based therapy after a median of 21.7 months (range=10.5-24.9) of lamivudine (LAM)+TDF, while the remaining patient had 46.8 months of prior LAM exposure. Significant decreases in HDV-RNA were observed in both groups [TDF alone: -0.380 log10 copies/ml per year (95% CI: -0.557, -0.202) vs. TDF+IFN: -1.325 log10 copies/ml per year (95% CI: -1.931, -0.720)], while the HDV-RNA decline overall was significantly faster in patients with TDF+IFN (p=0.002). Accordingly, two patients achieved HDV-RNA below the limit of quantification (LOQ: <1,000 copies/ml) and one near LOQ (1450 copies/ml), all concomitantly treated with interferon. There were no significant changes in HBsAg levels for either group [TDF alone: -0.008 log10 IU/ml per month (95% CI: -0.019, 0.004), TDF+IFN:-0.011 log10 IU/ml per month (95% CI: -0.037, 0.015)] and no significant difference in slope between treatment groups (p=0.8). Interferon therapy might be more effective after extended previous anti-HBV antiviral exposure among triinfected patients; however, the long-term implications of these findings remain unknown.
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Affiliation(s)
| | - Patrick Miailhes
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service des Maladies Infectieuses et Tropicales, Lyon, France
- Université Lyon 1, Lyon, France
| | - Ségolène Brichler
- AP-HP, Service de Bactériologie-Virologie-Hygiéne, associé au CNR des Hépatites B, C et Delta, Hôpital Avicenne, and Université Paris 13, Bobiogny, France
- Inserm, U955, Créteil, France
| | - Caroline Scholtès
- Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Laboratoire de Virologie, Lyon, France and Université Lyon 1, Lyon, France
| | - Sarah Maylin
- AP-HP, Service de Virologie, Hôpital Saint-Louis, Paris, France
| | | | - Phillipe Chevallier-Queyron
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Laboratoire de Virologie, Lyon, France and Université Lyon 1, Lyon, France
| | - Emmanuel Gordien
- AP-HP, Service de Bactériologie-Virologie-Hygiéne, associé au CNR des Hépatites B, C et Delta, Hôpital Avicenne, and Université Paris 13, Bobiogny, France
- Inserm, U955, Créteil, France
| | - Pierre-Marie Girard
- Inserm, UMRS707, Paris, France
- Université Pierre et Marie Curie – Paris VI, Paris, France
- AP-HP, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France
| | - Karine Lacombe
- Inserm, UMRS707, Paris, France
- Université Pierre et Marie Curie – Paris VI, Paris, France
- AP-HP, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France
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30
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Is HBsAg quantification ready, for prime time? Clin Res Hepatol Gastroenterol 2013; 37:559-63. [PMID: 23932705 DOI: 10.1016/j.clinre.2013.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/01/2013] [Indexed: 02/04/2023]
Abstract
Despite the availability of an efficient hepatitis B vaccine, approximately 240 million individuals are chronically infected with hepatitis B virus worldwide. One-fourth of hepatitis B surface antigen (HBsAg)-positive patients will develop complications, such as cirrhosis or hepatocellular carcinoma, both major causes of liver-related deaths. Antiviral therapies, such as pegylated interferon alpha or nucleoside/nucleotide analogues, are effective in suppressing HBV DNA and reducing the subsequent risk of fibrosis progression, cirrhosis and hepatocellular carcinoma. HBsAg has proven to be a steady, reliable marker of chronic HBV carriage that can also be used to predict clinical outcomes. Three commercial enzyme immunoassays are now available for HBsAg quantification. A number of recent studies have shown clinical utility of HBsAg quantification in combination with HBV DNA levels to identify inactive carriers who need antiviral therapy and in interferon treated-patients in order to predict the virological response to pegylated interferon alpha.
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31
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Tenofovir-based combination therapy for HIV/HBV co-infection: factors associated with a partial HBV virological response in patients with undetectable HIV viraemia. AIDS 2013; 27:1443-8. [PMID: 23435302 DOI: 10.1097/qad.0b013e32836011c2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to identify and describe patients with detectable hepatitis B virus (HBV) DNA in the presence of undetectable HIV RNA after 48 weeks of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) or lamivudine (3TC) treatment. DESIGN Case-control study. Cases or delayed responders were defined as detectable HBV DNA (>20 IU/ml) with undetectable HIV RNA (<40 c/ml) after 48 weeks TDF/3(F)TC combination therapy. Controls or virological responders were defined as both undetectable HIV and HBV after 48 weeks TDF/3(F)TC therapy. RESULTS Twenty-three cases were identified and matched to 24 controls. 87% cases and 46% controls were eAg-positive (P=0.005). Nine of 23 (39%) cases and seven of 24 (29%) controls had 3TC monotherapy prior to TDF. Similar proportions had 3TC/FTC resistance pre-TDF (30% cases, 24% controls). The cases had significantly higher baseline HBV DNA pre-3TC (median 1.2×10(8) vs. 3.1×10(6) IU/ml; P=0.009) and pre-TDF (1.1×10(8) vs. 2.6×10(4) IU/ml; P=0.012). Sixteen of 23 cases eventually achieved undetectable HBV DNA after 42.2 (27.2, 54.9) months. Six of 23 still have detectable HBV DNA after 46.2 (28.2, 65.6) months. Only one delayed responder patient developed a new 3(F)TC mutation and they received intensification with entecavir and achieved undetectable HBV DNA. No patient developed TDF resistance. CONCLUSION We report the largest series of HIV/HBV co-infected patients failing to achieve undetectable HBV after 48 weeks TDF/3(F)TC despite undetectable HIV viraemia. This outcome was associated with positive eAg and higher baseline HBV DNA. Our data suggest that clinicians should not intensify therapy with entecavir unless there is evidence of new 3TC/FTC mutations as the majority of patients go on to suppress HBV. TDF resistance was not seen.
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Matthews GV, Ali RJ, Avihingsanon A, Amin J, Hammond R, Bowden S, Lewin SR, Sasadeusz J, Littlejohn M, Locarnini SL, Ruxrungtham K, Dore GJ. Quantitative HBsAg and HBeAg predict hepatitis B seroconversion after initiation of HAART in HIV-HBV coinfected individuals. PLoS One 2013; 8:e61297. [PMID: 23593455 PMCID: PMC3622017 DOI: 10.1371/journal.pone.0061297] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 03/08/2013] [Indexed: 01/04/2023] Open
Abstract
Objective Anti-HBe seroconversion and HBsAg loss are important therapeutic endpoints in patients with hepatitis B virus (HBV) infection. Quantitative measures of hepatitis B surface antigen (qHBsAg) and e antigen (qHBeAg) have been identified as potentially useful indicators of therapeutic response in HBV monoinfection. The aim of this study was to examine serological change including quantitative biomarkers in HIV-HBV coinfected patients initiating HBV active antiretroviral therapy (ART). Methods HIV-HBV coinfected individuals from Thailand were followed for up to 168 weeks post ART. Rates and associations of qualitative serological change were determined. Longitudinal changes in qHBsAg and qHBeAg were measured and their utility as predictors of response examined. Results Forty seven patients were included of whom 27 (57%) were HBeAg positive at baseline. Median CD4 count was 48 cells/mm3. Over a median follow-up of 108 weeks 48% (13/27) lost HBeAg, 12/27 (44%) achieved anti-HBe seroconversion and 13% (6/47) HBsAg loss. Anti-HBe seroconversion was associated with higher baseline ALT (p = 0.034), lower qHBsAg (p = 0.015), lower qHBeAg (p = 0.031) and greater HBV DNA decline to week 24 (p = 0.045). Sensitivity and specificity for qHBsAg and qHBeAg decline of >0.5 log at week 12 and >1.0 log at week 24 were high for both anti-HBe seroconversion and HBsAg loss. Conclusions Rates of serological change in these HIV-HBV coinfected individuals with advanced immunodeficiency initiating HBV-active ART were high. Baseline and on treatment factors were identified that were associated with a greater likelihood of subsequent anti-HBe seroconversion, including both quantitative HBsAg and HBeAg, suggesting these biomarkers may have utility in this clinical setting.
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Affiliation(s)
- Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, Australia.
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Chevaliez S, Hézode C, Bahrami S, Grare M, Pawlotsky JM. Long-term hepatitis B surface antigen (HBsAg) kinetics during nucleoside/nucleotide analogue therapy: finite treatment duration unlikely. J Hepatol 2013; 58:676-83. [PMID: 23219442 DOI: 10.1016/j.jhep.2012.11.039] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/19/2012] [Accepted: 11/20/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Information regarding long-term HBsAg kinetics during treatment with nucleoside/nucleotide analogues is limited. The aim of the present study was to assess whether finite nucleoside/nucleotide analogue treatment duration could be envisaged during the patient's lifetime. METHODS Patients with chronic hepatitis B receiving different schedules of nucleoside/nucleotide analogues were followed for a median duration of 102 months, i.e., 8.5 years (interquartile range: 88-119 months). Long-term HBV DNA and HBsAg level kinetics were modeled in order to estimate time to clear HBsAg during therapy in patients with undetectable HBV DNA. RESULTS Antiviral therapy was associated with a slow but consistent reduction in the level of HBsAg in most of the patients. Three patterns of HBsAg level declines were identified: decline during both the detectable and undetectable HBV DNA phases; decline during the HBV DNA detectable period only; decline during the HBV DNA undetectable period only. The mean HBsAg titer at the time when HBV DNA became undetectable was 3.29 ± 0.49 Log₁₀ international units (IU)/ml, and the mean slope was -0.007 ± 0.007 Log₁₀ IU/month, i.e., an average decline of 0.084 Log₁₀ IU/year. The corresponding calculated median number of years needed to clear HBsAg was 52.2 years (interquartile range: 30.8-142.7). CONCLUSIONS This study, based on the very long-term follow-up of patients with chronic hepatitis B treated with potent nucleoside/nucleotide analogues, shows that HBsAg clearance is unlikely to occur during the patient's lifetime, even if HBV replication is well controlled. Thus, lifetime therapy is required in the vast majority of HBV-infected patients.
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Affiliation(s)
- Stéphane Chevaliez
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.
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Quantification of hepatitis B e antigen between Elecsys HBeAg and Architect HBeAg assays among patients infected with hepatitis B virus. J Clin Virol 2013; 56:306-11. [DOI: 10.1016/j.jcv.2012.12.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/28/2012] [Accepted: 12/13/2012] [Indexed: 01/05/2023]
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Coffin CS, Osiowy C, Myers RP, Gill MJ. Virology and clinical sequelae of long-term antiviral therapy in a North American cohort of hepatitis B virus (HBV)/human immunodeficiency virus type 1 (HIV-1) co-infected patients. J Clin Virol 2013; 57:103-8. [PMID: 23465393 DOI: 10.1016/j.jcv.2013.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/01/2013] [Accepted: 02/05/2013] [Indexed: 02/07/2023]
Abstract
UNLABELLED There are limited recent data worldwide on clinical and virological outcomes in hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfected patients on dual active antiretroviral therapy (ART). METHODS We completed a retrospective review of 53 coinfected patients. HBV DNA in plasma was tested by PCR (sensitivity <20-<55 IU/ml or ∼100-300 copies/ml, Roche Diagnostics). Quantitative hepatitis B surface antigen (qHBsAg) was measured by an in-house assay (calibration range 0.24-62.5 IU/ml). HBV genotyping was done by line probe assay, and HBV variants determined by sequencing the HBV polymerase (P)/overlapping surface (S) gene. RESULTS There were 7% (4/53) non-liver related deaths, ∼11% (6/53) had >F2 fibrosis, including 3 with cirrhosis. The median CD4+ T cell count was 415 cells/mm(3) (range 60-1310). 54% (28/51) were HBeAg-positive, and 81% (43/53) on ART had undetectable HBV DNA but only 5% (3/51) lost HBeAg. In 11/53 with HBV sequencing, 90% (10/11) were found to have HBV genotype A (HBV-A) and/or 27% (3/11) had a mixed A/G infection. Anti-HBV drug resistant mutations were detected in 54% (6/11) (i.e., any combination of rtV173L, rtL180M, M204V) and 45% (5/11) had an immune escape mutation (sP120S). In 12 with qHBsAg testing, the majority (9/12) had low-level qHBsAg ∼1-3 log(10) IU/ml. SUMMARY Liver disease occurs in ∼10% of coinfected patients on ART and many have low-level HBV DNA and qHBsAg. In those sequenced most were HBV-A or mixed A/G genotype, and several carry P and S mutants highlighting the complex molecular virology of HBV during HIV coinfection.
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Affiliation(s)
- C S Coffin
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, 3280 Hospital Drive NW, University of Calgary, Calgary, AB T2N 4Z6, Canada.
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Arendt E, Jaroszewicz J, Rockstroh J, Meyer-Olson D, Zacher BJ, Mederacke I, Manns MP, Wedemeyer H, Cornberg M, Wursthorn K. Improved Immune Status Corresponds with Long-Term Decline of Quantitative Serum Hepatitis B Surface Antigen in HBV/HIV Co-infected Patients. Viral Immunol 2012; 25:442-7. [DOI: 10.1089/vim.2012.0036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Eduard Arendt
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
| | - Jerzy Jaroszewicz
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
- Department of Infectious Diseases and Hepatology, Medical University in Bialystok, Bialystok, Poland
| | - Jürgen Rockstroh
- Department of Internal Medicine III, Bonn University, Bonn, Germany
| | - Dirk Meyer-Olson
- Department of Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Behrend J. Zacher
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
| | - Karsten Wursthorn
- Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
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Jaroszewicz J, Reiberger T, Meyer-Olson D, Mauss S, Vogel M, Ingiliz P, Payer BA, Stoll M, Manns MP, Schmidt RE, Flisiak R, Wedemeyer H, Peck-Radosavljevic M, Rockstroh J, Cornberg M. Hepatitis B surface antigen concentrations in patients with HIV/HBV co-infection. PLoS One 2012; 7:e43143. [PMID: 22905219 PMCID: PMC3419648 DOI: 10.1371/journal.pone.0043143] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 07/17/2012] [Indexed: 01/01/2023] Open
Abstract
HBsAg clearance is associated with clinical cure of chronic hepatitis B virus (HBV) infection. Quantification of HBsAg may help to predict HBsAg clearance during the natural course of HBV infection and during antiviral therapy. Most studies investigating quantitative HBsAg were performed in HBV mono-infected patients. However, the immune status is considered to be important for HBsAg decline and subsequent HBsAg loss. HIV co-infection unfavorably influences the course of chronic hepatitis B. In this cross-sectional study we investigated quantitative HBsAg in 173 HBV/HIV co-infected patients from 6 centers and evaluated the importance of immunodeficiency and antiretroviral therapy. We also compared 46 untreated HIV/HBV infected patients with 46 well-matched HBV mono-infected patients. HBsAg levels correlated with CD4 T-cell count and were higher in patients with more advanced HIV CDC stage. Patients on combination antiretroviral therapy (cART) including nucleos(t)ide analogues active against HBV demonstrated significant lower HBsAg levels compared to untreated patients. Importantly, HBsAg levels were significantly lower in patients who had a stronger increase between nadir CD4 and current CD4 T-cell count during cART. Untreated HIV/HBV patients demonstrated higher HBsAg levels than HBV mono-infected patients despite similar HBV DNA levels. In conclusion, HBsAg decline is dependent on an effective immune status. Restoration of CD4 T-cells during treatment with cART including nucleos(t)ide analogues seems to be important for HBsAg decrease and subsequent HBsAg loss.
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Affiliation(s)
- Jerzy Jaroszewicz
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
- German Center for Infectious Disease Research (DZIF)
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Dirk Meyer-Olson
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
- German Center for Infectious Disease Research (DZIF)
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Martin Vogel
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- German Center for Infectious Disease Research (DZIF)
| | - Patrick Ingiliz
- Medical Center for Infectious Diseases (MIB), Berlin, Germany
| | - Berit Anna Payer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Matthias Stoll
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
- German Center for Infectious Disease Research (DZIF)
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infectious Disease Research (DZIF)
| | - Reinhold E. Schmidt
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
- German Center for Infectious Disease Research (DZIF)
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infectious Disease Research (DZIF)
| | - Markus Peck-Radosavljevic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Jürgen Rockstroh
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- German Center for Infectious Disease Research (DZIF)
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infectious Disease Research (DZIF)
- * E-mail:
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Long-term hepatitis B virus surface antigen decay in HIV-1/hepatitis B virus-coinfected adults initiating a tenofovir-containing regimen. J Clin Microbiol 2012; 50:3096-8. [PMID: 22760046 DOI: 10.1128/jcm.00971-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hepatitis B virus (HBV) surface antigen (HBsAg) decay was explored in HIV-1- and HBV-coinfected patients beginning antiretroviral (ARV) therapy containing tenofovir disoproxil fumarate (TDF). The mean HBsAg decay was 0.38 log(10) IU/ml/year (95% confidence interval [CI], 0.71 to 0.05) in 18 patients with sustained plasma HIV-1 RNA suppression and 0.15 log(10) IU/ml/year (0.21 to 0.09) in 12 patients experiencing HIV-1 virologic failure due to suboptimal adherence to ARV (P = 0.17). We estimated that six of these 18 patients will attain HBsAg values below 10 IU/ml after 10 years of treatment.
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