Higher rates of HBsAg clearance with tenofovir-containing therapy in HBV/HIV co-infection

Abstract

Introduction Achieving functional cure of chronic HBV infection (Hepatitis B surface antigen [HBsAg] clearance, eventually followed by acquisition of anti-hepatitis B surface antigen [Anti-HBs]) in individuals with HIV and HBV infections is a rare event. In this setting, factors related to HBV cure have not yet been fully characterized. Methods HIV-infected individuals with chronic HBV infection enrolled in the French Dat’AIDS cohort (NCT02898987), who started combined antiretroviral (cART)-anti-HBV treatment were retrospectively analyzed for HBsAg loss and Anti-HBs seroconversion. Results Overall, 1419 naïve-subjects received three different cART-anti-HBV treatment schedule: (1) 3TC or FTC only (n = 150), (2) TDF with or without 3TC or FTC (n = 489) and (3) 3TC or FTC as first line followed by adding/switching to TDF as second line (n = 780). Individuals were followed-up for a median of 89 months (IQR, 56–118). HBV-DNA was < 15 IU/mL in 91% of individuals at the end of the follow-up. Overall, 97 individuals cleared HBsAg (0.7/100 patient-years), of whom, 67 seroconverted for Anti-HBs (0.5/100 patient-years). A high CD4 nadir, a short delay between HBV diagnosis and treatment, a longer time on HBV therapy, an African origin and TDF-based therapy were independent predictors of HBsAg clearance (Probability of odds ratio [OR]>1, >95%) suggested by Bayesian analysis. Also, TDF-based regimen as first line (OR, 3.03) or second line (OR, 2.95) increased rates of HBsAg clearance compared to 3TC or FTC alone, with a 99% probability. Conclusions HBsAg clearance rate was low in HIV-HBV co-infected cART-anti-HBV treated individuals, but was slightly improved on TDF-based regimen.

Possible association of <i>HLA-DP</i> polymorphism and antiretroviral therapy with hepatitis B virus clearance in an HIV-infected Vietnamese population

“…This result may be attributed to the relatively longer follow-up period in our study. In addition to TDF containing ART, higher CD4+ T cell counts have been identified in previous studies (20,21). Our findings in the prospective study indicate that no factors are associated with HBsAg clearance; this may be attributed to the small sample size.…”

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

“…In settings where HBV is endemic (with vertical transmission during birth occurring more frequently in Asia and horizonal transmission between children/youth occurring in Africa), HIV is commonly acquired well after HBV infection, whereas in settings where HBV is non-endemic (with sexual transmission or injecting drug use in Europe, Australia, and North America), HIV and HBV acquisition are commonly acquired at the same time [ 50 ]. Accordingly, a large study of treated HIV-HBV co-infected individuals has demonstrated that those of African origin have a much higher probability of being able to clear HBsAg than Caucasians [ 51 ]. Older age has also been commonly found to be associated with HBsAg-seroclearance in treated co-infected individuals [ 52 ], which might also reflect individuals with longer duration of HBV infection.…”

Obstacles to HBV functional cure: Late presentation in HIV and its impact on HBV seroconversion in HIV/HBV coinfection

“…This may be because of different host factors like Human Leukocyte Antigen polymorphisms which have an impact on HBV persistence, seroclearance and progression in HBV monoinfected individuals. Concerning HIV/HBV coinfected individuals Gantner et al recently attributed African ethnicity a better prognosis of achieving HBV functional cure 11 . Data from Jain et al found Hispanic origin and AIDS diagnosis at baseline being favourable for clearing HBsAg 12 .…”