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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

Matthews, Gail V.a; Manzini, Princeb; Hu, Zonghuic; Khabo, Paulb; Maja, Patrickb; Matchaba, Gugub; Sangweni, Phumeleb; Metcalf, Juliec; Pool, Nicholaasd; Orsega, Susanc; Emery, Seana; on behalf of the PHIDISA II study team

doi: 10.1097/QAD.0b013e328349bbf3
Clinical Science

Objective: To examine HIV and hepatitis B virus (HBV)-related outcomes in HIV/HBV-coinfected participants in the PHIDISA II study by use of HBV-active vs. non-HBV-active antiretroviral therapy (ART).

Design and methods: PHIDISA II was a randomized study of ART therapy in HIV-infected adults employing zidovudine along with didanosine, or lamivudine along with stavudine in a factorial 2x2 design. HIV/HBV-coinfected participants by randomization received HBV-active or non-HBV-active ART. The following outcomes of interest were examined: immunological recovery and HIV RNA suppression; hepatic flare; HBV DNA suppression; and mortality.

Results: HIV/HBV coinfection was present in 106 of 1771 (6%) of participants. Participants with HIV/HBV coinfection were more likely to be men, and have higher baseline alanine aminotransferase, lower albumin, and lower platelets than those with HIV monoinfection. Median CD4 cell gain and HIV RNA suppression was similar across all groups. Hepatic flare was observed in 9.4% of coinfected and 0.02% monoinfected participants. HBV DNA suppression (<55 IU/ml) at week 48 was observed in only 33% of those on lamivudine vs. 13% in those on no HBV-active drugs (P = 0.13). Mortality over follow-up was significantly greater in coinfected (17%) than monoinfected (11%) participants (P = 0.04).

Conclusion: In summary, the use of lamivudine-containing ART in HIV/HBV participants in PHIDISA II resulted in little additional benefit over that of ART itself and failed to impact on the greater mortality in this group. These data provide strong support for recent guidelines advocating the use of tenofovir in all HIV–HBV-coinfected individuals initiating ART.

aNational Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia

bProject PHIDISA, South African Military Health Services, South African National Defence Force, Centurion, South Africa

cNational Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA

dBio-Analytical Research Corporation PTY LTD, Johannesburg, South Africa.

Correspondence to Gail Matthews, MBChB, MRCP, FRACP, PhD, National Centre in HIV Epidemiology and Clinical Research, Cnr West and Boundary Streets, Darlinghurst, Sydney, NSW 2010, Australia. Tel: +61 2 9385 0900; fax: +61 2 9385 0876; e-mail:

Received 1 May, 2011

Revised 7 June, 2011

Accepted 9 June, 2011

© 2011 Lippincott Williams & Wilkins, Inc.