Impact of lamivudine on HIV and hepatitis B virus-related outcomes in HIV/hepatitis B virus individuals in a randomized clinical trial of antiretroviral therapy in southern Africa

Matthews, Gail V.; Manzini, Prince; Hu, Zonghui; Khabo, Paul; Maja, Patrick; Matchaba, Gugu; Sangweni, Phumele; Metcalf, Julie; Pool, Nicholaas; Orsega, Susan; Emery, Sean

doi:10.1097/qad.0b013e328349bbf3

Cited by 46 publications

(48 citation statements)

References 28 publications

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“…In a large randomized trial of lamivudine monotherapy in HBV-infected children, 23% had undetectable HBV DNA and loss of HBeAg after 52 weeks of treatment; however, 64% developed lamivudine resistance after 3 years of treatment [104,108]. Due to the increased risk of resistance and the lack of clear longterm efficacy in HIV/HBV-coinfected adults, lamivudine as the only anti-HBV active agent in a regimen is not recommended in coinfected adults [35,92,109]. Importantly, lamivudine and the similar agent, emtricitabine, are active against HIV, and HIV resistance develops rapidly when they are used as single agents.…”

Section: Treatmentmentioning

confidence: 99%

HIV/HBV coinfection in children and antiviral therapy

Healy

Gupta

Melvin

2013

Expert Review of Anti-infective Therapy

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Small cohort studies from countries where both HIV and HBV are endemic demonstrate prevalence rates of chronic hepatitis B in HIV-infected children of between 1 and 49%. While data on coinfected children are limited, results from studies in adults with HIV/HBV coinfection raise the concern that coinfected children may be at a higher risk of liver disease, hepatic fibrosis and cirrhosis. With the scale-up of combination antiretroviral therapy worldwide, of which lamivudine is included in most first-line regimens, coinfected children treated with lamivudine risk development of HBV resistance mutations. This article summarizes the current literature relevant to HIV/HBV coinfection in children, the options for treatment and highlights priorities for future research.

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Section: Treatmentmentioning

confidence: 99%

HIV/HBV coinfection in children and antiviral therapy

Healy

Gupta

Melvin

2013

Expert Review of Anti-infective Therapy

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“…8,9 To date, the sparse literature on HBsAg seroclearance in SSA includes only small numbers of patients and extends to roughly one year of follow-up. 10,11 This period would be judged fairly inadequate given that HBsAg loss is most likely to occur within the first 3 years of treatment. 9 The aim of the study herein is then to estimate the rates of HBsAg seroclearance and its determinants among HIV-HBV patients from Côte d'Ivoire initiating either a lamivudine (LAM) or TDFcontaining ART regimen.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B surface antigen quantification as a predictor of seroclearance during treatment in HIV‐hepatitis B virus coinfected patients from Sub‐Saharan Africa

Boyd

Maylin

Moh

et al. 2016

J of Gastro and Hepatol

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International audienceAbstractBackground and AimIn 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).MethodsIn 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.ResultsOverall, 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).ConclusionsHBsAg 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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“…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]. However, these data have not been replicated in other studies [16, 17].…”

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confidence: 99%

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

Anderson

Gaseitsiwe

Moyo

et al. 2016

Open Forum Infectious Diseases

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Background. Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection has emerged as an important cause of morbidity and mortality. We determined the response to Truvada-based first-line combination antiretroviral therapy (cART) in HIV/HBV-coinfected verus HIV-monoinfected patients in Botswana.Methods. Hepatitis B virus surface antigen (HBsAg), HBV e antigen (HBeAg), and HBV deoxyribonucleic acid (DNA) load were determined from baseline and follow-up visits in a longitudinal cART cohort of Truvada-based regimen. We assessed predictors of HBV serostatus and viral suppression (undetectable HBV DNA) using logistic regression techniques.Results. Of 300 participants, 28 were HBsAg positive, giving an HIV/HBV prevalence of 9.3% (95% confidence interval [CI], 6.3–13.2), and 5 of these, 17.9% (95% CI, 6.1–36.9), were HBeAg positive. There was a reduced CD4+ T-cell gain in HIV/HBV-coinfected compared with HIV-monoinfected patients. Hepatitis B virus surface antigen and HBeAg loss was 38% and 60%, respectively, at 24 months post-cART initiation. The HBV DNA suppression rates increased with time on cART from 54% to 75% in 6 and 24 months, respectively.Conclusions. Human immunodeficiency virus/HBV coinfection negatively affected immunologic recovery compared with HIV-1C monoinfection. Hepatitis B virus screening before cART initiation could help improve HBV/HIV treatment outcomes and help determine treatment options when there is a need to switch regimens.

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Impact of lamivudine on HIV and hepatitis B virus-related outcomes in HIV/hepatitis B virus individuals in a randomized clinical trial of antiretroviral therapy in southern Africa

Cited by 46 publications

References 28 publications

HIV/HBV coinfection in children and antiviral therapy

HIV/HBV coinfection in children and antiviral therapy

Hepatitis B surface antigen quantification as a predictor of seroclearance during treatment in HIV‐hepatitis B virus coinfected patients from Sub‐Saharan Africa

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

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