Association of Hepatitis B Core-Related Antigen and Antihepatitis B Core Antibody With Liver Fibrosis Evolution in Human Immunodeficiency Virus-Hepatitis B Virus Coinfected Patients During Treatment With Tenofovir

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Quantitative hepatitis B core-related antigen (qHBcrAg) or antihepatitis B core antibody (qAnti-HBc) could be useful in monitoring liver fibrosis evolution during chronic hepatitis B virus (HBV) infection, yet it has not been assessed in human immunodeficiency virus (HIV)-HBV-coinfected patients undergoing treatment with tenofovir (TDF).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>One hundred fifty-four HIV-HBV-infected patients initiating a TDF-containing antiretroviral regimen were prospectively followed. The qHBcrAg and qAnti-HBc and liver fibrosis assessment were collected every 6–12 months during TDF. Hazard ratios (HRs) assessing the association between qHBcrAg/qAnti-HBc and transitions from none/mild/significant fibrosis to advanced fibrosis/cirrhosis (progression) and from advanced fibrosis/cirrhosis to none/mild/significant fibrosis (regression) were estimated using a time-homogeneous Markov model.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>At baseline, advanced liver fibrosis/cirrhosis was observed in 40 (26%) patients. During a median follow-up of 48 months (interquartile range, 31–90), 38 transitions of progression (IR = 7/100 person-years) and 34 transitions of regression (IR = 6/100 person-years) were observed. Baseline levels of qHBcrAg and qAnti-HBc were not associated with liver fibrosis progression (adjusted-HR per log10 U/mL = 1.07, 95% confidence interval [CI] = 0.93–1.24; adjusted-HR per log10 Paul-Ehrlich-Institute [PEI] U/mL = 0.85, 95% CI = 0.70–1.04, respectively) or regression (adjusted-HR per log10 U/mL = 1.17, 95% CI = 0.95–1.46; adjusted-HR per log10 PEI U/mL = 0.97, 95% CI = 0.78–1.22, respectively) after adjusting for age, gender, duration of antiretroviral therapy, protease inhibitor-containing antiretroviral therapy, and CD4+/CD8+ ratio. Nevertheless, changes from the previous visit of qAnti-HBc levels were associated with liver fibrosis regression (adjusted-HR per log10 PEIU/mL change = 5.46, 95% CI = 1.56–19.16).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Baseline qHBcrAg and qAnti-HBc levels are not associated with liver fibrosis evolution in TDF-treated HIV-HBV coinfected patients. The link between changes in qAnti-HBc levels during follow-up and liver fibrosis regression merits further study.</jats:p> </jats:sec>

Functional Cure of Hepatitis B Virus Infection in Individuals With HIV-Coinfection: A Literature Review

“…One study in TDF-treated HIV-HBV co-infected individuals has been performed evaluating anti-HBc levels, showing that higher levels of this marker at TDF-treatment initiation were only able to exhibit high specificity in predicting HBeAg-seroclearance [ 89 ]. Although this marker did not perform well in predicting HBeAg-seroclearance, its changes during treatment were associated with sudden decreases liver fibrosis levels [ 106 ]. No evaluation of this marker has been made on HBsAg-seroclearance in the treated, HIV-HBV co-infected population.…”

Clinical Utility of Quantitative HBV Core Antibodies for Solving Diagnostic Dilemmas

“…Combining qAnti-HBc with two routine serum parameters, PLT (platelet count) and A/G (albumin to globulin ratio), achieved further improvement of the diagnostic accuracy [ 52 ]. On the other hand, Cruchet et al (2020) did not observe an association of baseline qAnti-HBc level with liver fibrosis evolution in tenofovir-treated HIV/HBV co-infected patients [ 53 ]. Curiously, the increase of qAnti-HBc level was linked with a transition to lower fibrosis levels in these patients.…”

“…[ 19 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] (prediction of hepatic inflammation grade), refs. [ 50 , 51 , 52 , 53 ] (prediction of fibrosis stage), ref. [ 54 ] (prediction of response after TACE therapy for HCC), ref.…”