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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000126
Epidemiology and Prevention

Factors Associated With Delayed Hepatitis B Viral Suppression on Tenofovir Among Patients Coinfected With HBV-HIV in the CNICS Cohort

Kim, H. Nina MD, MSc*; Rodriguez, Carla V. PhD*; Van Rompaey, Stephen PhD*; Eron, Joseph J. MD; Thio, Chloe L. MD, MPH; Crane, Heidi M. MD, MPH*; Overton, Edgar T. MD§; Saag, Michael S. MD§; Martin, Jeffrey MD, MPH; Geng, Elvin MD, MPH; Mugavero, Michael MD§; Rodriguez, Benigno MD; Mathews, W. Christopher MD, MPH#; Boswell, Stephen MD**; Moore, Richard MD; Kitahata, Mari M. MD, MPH*; for the Centers for AIDS Research Network of Integrated Clinical Systems

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Abstract

Background: Despite widespread use in HIV and hepatitis B virus (HBV) infection, the effectiveness of tenofovir (TDF) has not been studied extensively outside of small cohorts of coinfected patients with HBV-HIV. We examined the effect of prior lamivudine (3TC) treatment and other factors on HBV DNA suppression with TDF in a multisite clinical cohort of coinfected patients.

Methods: We studied all patients enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems cohort from 1996 to 2011 who had chronic HBV and HIV infection, initiated a TDF-based regimen continued for ≥3 months and had on-treatment HBV DNA measurements. We used Kaplan–Meier curves and Cox-proportional hazards to estimate time to suppression (HBV DNA level <200 IU/mL or <1000 copies/mL) by selected covariates.

Results: Among 397 coinfected patients on TDF, 91% were also on emtricitabine or 3TC concurrently, 92% of those tested were hepatitis B e antigen positive, 196 (49%) had prior 3TC exposure; 192 (48%) achieved HBV DNA suppression over a median of 28 months (interquartile range: 13–71). Median time to HBV DNA suppression was 17 months for those who were 3TC-naive and 50 months for those who were 3TC exposed. After controlling for other factors, prior 3TC exposure, baseline HBV DNA level >10,000 IU/mL, and lower nadir CD4 count were independently associated with decreased likelihood of HBV DNA suppression on TDF.

Conclusions: These results emphasize the role of prior 3TC exposure and immune response on delayed HBV suppression on TDF.

© 2014 by Lippincott Williams & Wilkins

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