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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182a60f7d
Clinical Science

HIV–HBV Coinfection in Southern Africa and the Effect of Lamivudine- Versus Tenofovir-Containing cART on HBV Outcomes

Hamers, Raph L. MD, PhD*,†,‡; Zaaijer, Hans L. MD, PhD§,‖; Wallis, Carole L. PhD¶,#; Siwale, Margaret MD**; Ive, Prudence MD††; Botes, Mariette E. MD‡‡; Sigaloff, Kim C. E. MD, PhD*,†,‡; Hoepelman, Andy I. M. MD, PhD§§; Stevens, Wendy S. MD, MMed; Rinke de Wit, Tobias F. PhD*,†,‡; PharmAccess African Studies to Evaluate Resistance (PASER)

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Abstract

Background: This study assessed HIV–hepatitis B virus (HBV) coinfection in southern Africa in terms of prevalence, viral characteristics, occult HBV, and the effect of lamivudine- versus tenofovir-containing first-line combination antiretroviral treatment (cART) on HBV-related outcomes.

Methods: A multicenter prospective cohort of HIV-infected adults in Zambia and South Africa who initiated cART. Outcomes by month 12 on cART were immunological recovery, hepatitis B surface antigen (HBsAg) loss, viral suppression, and drug resistance. We used descriptive statistics, logistic regression, and linear mixed models.

Results: Of the 1087 participants, 92 were HBsAg seropositive, yielding a sample-weighted prevalence of 7.4% (95% confidence interval: 5.6 to 9.2), with 76% genotype HBV-A1. The estimated CD4 recovery on cART was similar between HIV monoinfection and HIV–HBV coinfection groups and between lamivudine- and tenofovir-treated participants. HBsAg loss was documented in 20% (4/20) of lamivudine-treated and 18% (3/17) of tenofovir-treated participants (P = 0.305). Viral suppression (HBV-DNA < 20 IU/mL) was achieved in 61.5% (16/26) of lamivudine-treated and 71.4% (15/21) of tenofovir-treated participants (P = 0.477). HBV pol sequencing demonstrated M204I (n = 3) and N236T (n = 1) resistance-associated mutations in 4 of 8 (50%) lamivudine-treated participants and none in tenofovir-treated participants. Occult HBV infection was present in 13.3% before cART, but by month 12, HBV-DNA was below the limit of detection (<15 IU/mL) in 90.5% (19/21) of lamivudine-treated and 100% (18/18) of tenofovir-treated participants (P = 0.179).

Conclusions: Tenofovir-containing first-line cART is preferred for HIV–HBV coinfection in Africa because of a superior resistance profile relative to lamivudine monotherapy. Extended follow-up will be needed to determine long-term complications of occult HBV coinfection. Improved access to HBsAg screening and tenofovir is needed.

© 2013 by Lippincott Williams & Wilkins

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