Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort

Abstract

Objective: Prompted by international targets for elimination of hepatitis B virus (HBV) infection, we performed a cross-sectional observational study of adults with chronic HBV (CHB) infection in South Africa, characterising individuals with HBV monoinfection vs. those coinfected with HBV/HIV, to evaluate the impact of therapy and to guide improvements in clinical care as guidelines for antiviral therapy change over time. Design: We prospectively recruited 115 adults with CHB, over a period of one year at a university hospital in Cape Town, South Africa. HIV coinfection was present in 39 (34%) subjects. We recorded cross-sectional demographic, clinical and laboratory data. Results: Adults with HBV monoinfection were comparable to those with HBV/HIV coinfection in terms of age, sex and body mass. HBeAg-positive status was more common among those with HIV coinfection (p=0.01). However, compared to HBV/HIV coinfection, HBV monoinfected patients were less likely to have had assessment with elastography (p<0.0001) and less likely to be on antiviral treatment (p<0.0001). The HBV monoinfected group was more likely to have detectable HBV viraemia (p=0.04), and features suggesting underlying liver disease including moderate/severe thrombocytopaenia (p=0.007), elevated bilirubin (p=0.004), and APRI score >2 (p=0.02). Three cases of hepatocellular carcinoma were documented, all in patients with HBV monoinfection. Conclusion: In this setting, individuals with HBV monoinfection are disadvantaged in terms of clinical assessment and appropriate antiviral therapy compared to those with HIV coinfection, associated with relatively worse liver health. Enhanced advocacy, education, resources and infrastructure are required to optimise interventions for CHB.

Evidence of tenofovir resistance in chronic hepatitis B virus (HBV) infection: An observational case series of South African adults

“…Adults were enrolled into a cross-sectional cohort of CHB at Tygerberg Hospital, Cape Town, South Africa (‘OxSAHep’ HBV study), as previously described [ 11 ]. All participants provided written informed consent.…”

Efficacy and safety of tenofovir disoproxil fumarate (TDF) in hepatitis B virus (HBV) monoinfection: longitudinal analysis of a UK cohort

“…Similar studies are needed in settings where other risk factors are more prevalent, e.g., populations where HIV is co-endemic. A study from South Africa demonstrates that adults with HIV/HBV coinfection on antiretroviral therapy have less chronic liver disease than those with HBV monoinfection, suggesting an advantage conferred by treatment in the coinfected group (55). We only compared patients on TDF treatment to untreated; due to infrequent use of ETV, we have not considered the small subgroup of our population treated with this agent.…”

Hepatitis B virus resistance to tenofovir: fact or fiction? A synthesis of the evidence to date

“…Assessment of adherence in chronic HBV has been through the use of questionnaires (51), but these are subject to self-reporting bias. Evidence of potential TFV resistance may emerge when individuals with HIV/HBV coinfection are treated with a TFV-containing regimen leading to suppression of HIV but with sustained HBV vireamia (52).…”

“…Studies assessing treatment adherence in chronic HBV have also used questionnaire-based approaches (66)(67)(68), but these are subject to bias as self-reporting of compliance may be inaccurate. Evidence of potential TFV resistance may emerge when individuals with HIV/HBV coinfection are treated with a TFV-containing regimen leading to suppression of HIV but with sustained HBV vireamia (69). Plasma, PBMCs and dried blood spots have been useful in assessing drug concentration in HIV infection (70)(71)(72)(73)(74), however, they only offer information on treatment exposure over a short period (typically 7-14 days) (74).…”