HBV lamivudine resistance among hepatitis B and HIV coinfected patients starting lamivudine, stavudine and nevirapine in Kenya

Abstract

Widespread use of lamivudine in antiretroviral therapy may lead to hepatitis B virus resistance in HIV-HBV co-infected patients from endemic settings where tenofovir is not readily available. We evaluated 389 Kenyan HIV-infected adults before and for 18 months after starting highly-active antiretroviral therapy with stavudine, lamivudine and nevirapine. Twenty-seven (6.9%) were HBsAg(+) and anti-HBs negative: 24 were HBeAg-negative, 18 had HBV DNA ≤10,000 IU/ml. Sustained HBV suppression to <100 IU/ml occurred in 89% of 19 evaluable patients. Resistance occurred in only 2 subjects, both with high baseline HBV DNA levels. Lamivudine resistance can emerge in the setting of incomplete HBV suppression but was infrequently observed among HIV-HBV co-infected patients with low baseline HBV DNA levels.

Slow CD4+ T-Cell Recovery in Human Immunodeficiency Virus/Hepatitis B Virus-Coinfected Patients Initiating Truvada-Based Combination Antiretroviral Therapy in Botswana

“…The pretreatment CD4 + T-cell counts in this study were similar between the 2 groups as reported by Kim et al [43] in Kenya [10]. This was also similar to another study that included Botswana and South African pregnant women, and the baseline CD4 + T cells for Batswana were similar between the HIV/HBV-coinfected and HIV-monoinfected group, whereas that of South Africans were lower in the HIV/HBV-coinfected group [45].…”

“…Human immunodeficiency virus has been shown to change the natural course of chronic HBV by increasing the likelihood of HBV infections acquired during adulthood to progress to chronic HBV infection [7], increasing rates of hepatitis e antigen positivity [8] and higher levels of HBV DNA [9] but lower alanine aminotransferase (ALT) levels and rapid liver disease progression [2]. Higher mortality has also been reported in HBV/HIV coinfection compared with HBV-monoinfected individuals [10, 11]. On the other hand, HBV has been reported to lead to higher baseline HIV viral load, lower CD4 + T cells, increased occurrences of advanced disease, lower body mass index (BMI), and increased mortality in HIV/HBV-coinfected participants compared with HIV-monoinfected individuals [12–15].…”

“…There is increasing access to tenofovir; thus, data on HBV response to tenofovir is important, especially in high HBV-endemic and resource-limited countries. There are conflicting data on the effects of HBV on HIV response to cART [1, 10, 11, 22, 23]. In this study, we determined HBV response to tenofovir containing first-line cART in HIV-infected individuals initiating cART by determining HBV surface antigen (HBsAg) loss, HBV e antigen (HBeAg) loss, and HBV deoxyribonucleic acid (DNA) levels at different time points during treatment.…”

Prevalence, Clinical and Virologic Outcomes of Hepatitis B Virus Co-Infection in HIV-1 Positive Kenyan Women on Antiretroviral Therapy

“…A retrospective analysis from The Gambia found lamivudine resistance mutations in 3 (14%) of 21 patients followed between 6 and 56 months [15]. Even lower levels of resistance were found in a recent prospective cohort study from Nairobi, Kenya, which reported that only 2 (9.5%) of 27 co-infected patients developed lamivudine resistance after 18 months of therapy [16].…”

Higher prevalence of Hepatitis B virus Infection among ARV- exposed than naive HIV-infected individuals in North Shewa Zone, Ethiopia

“…So if complete, suppression was not achieved during treatment, resistance commences rather quickly. Furthermore, within the first year of treatment, 20% of patients on lamivudine may develop mutation resulting in loss of effectiveness against HBV (Chang et al, 2005) and virologic breakthrough (Mauss et al, 2009;Kim et al, 2011). HIV might also reduce efficacy of anti-HBV therapy, including the risk of lamivudine resistance and decreased response to interferon α (Peters, 2007).…”