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Comparison of HBV-active HAART regimens in an HIV–HBV multinational cohort: outcomes through 144 weeks

Thio, Chloe L.a; Smeaton, Laurab; Hollabaugh, Kimberlyb; Saulynas, Melissaa; Hwang, Hyona; Saravanan, Shanmugamc; Kulkarni, Smitad; Hakim, Jamese; Nyirenda, Mulindaf; Iqbal, Hussain Syedc; Lalloo, Umesh G.g; Campbell, Thomas B.h; Lockman, Shahinb,i; Currier, Judith S.j

doi: 10.1097/QAD.0000000000000686
Clinical Science

Objectives: To explore factors associated with short and long-term hepatitis B virus (HBV) DNA suppression in a multinational cohort of HIV–HBV co-infected patients receiving HBV-active antiretrovirals.

Methods: One hundred and fifteen HIV–HBV co-infected patients participating in one of the two global randomized clinical trials conducted by the Adult AIDS Clinical Trials Group of different antiretroviral regimens received either HBV monotherapy with either lamivudine or emtricitabine (N = 56), or HBV dual therapy with tenofovir disoproxil fumarate (TDF) + lamivudine or emtricitabine (N = 59). Associations of pretreatment characteristics with the primary (HBV DNA <200 IU/ml at 24 weeks) and longitudinal outcomes through 144 weeks were explored using logistic regression. HBV drug-resistance mutations were determined by pol sequencing in those with viral rebound.

Results: The proportion with HBV DNA below 200 IU/ml was 60% (95% confidence interval 50–69%) at 24 weeks and 79% (95% confidence interval 69–88%) at 144 weeks. Pretreatment factors associated with the primary outcome were HBV DNA, CD4+ T-cell count, and aspartate aminotransferase, but only pretreatment HBV DNA remained associated with long-term suppression (P < 0.0001). HBV therapy group was not significantly associated with the primary outcome at 24 weeks; however, longitudinally, a greater proportion in the dual-therapy group achieved HBV DNA below 200 IU/ml (P = 0.007). A higher proportion of hepatitis B e antigen-negative patients (n = 57) achieved HBV DNA below 200 IU/ml at any point, regardless of the therapy group. All 12 patients with emergence of lamivudine-resistant mutants were in the monotherapy group.

Conclusions: TDF-based dual HBV-active antiretroviral therapy is preferred to treat HIV–HBV co-infected patients. In resource-limited settings in which TDF may not be universally available, lamivudine or emtricitabine HBV monotherapy is a reasonable option in patients with low HBV replication.

aJohns Hopkins University, Baltimore, Maryland

bHarvard School of Public Health, Boston, Massachusetts, USA

cYRG Centre for AIDS Research and Education, Voluntary Health Services Hospital Campus, Taramani, Chennai

dNational AIDS Research Institute-ICMR, Pune, India

eUniversity of Zimbabwe Clinical Research Centre, College of Health Sciences, Harare, Zimbabwe

fCollege of Medicine, Johns Hopkins Research Project, Department of Medicine, Blantyre, Malawi

gNelson R Mandela School of Medicine, University of KwaZulu-Natal, Glenwood, South Africa

hUniversity of Colorado School of Medicine, Aurora, Colorado

iBrigham and Women's Hospital, Boston, Massachusetts

jUCLA David Geffen School of Medicine, Los Angeles, California, USA.

Correspondence to Chloe L. Thio, MD, Professor of Medicine, Johns Hopkins University, 855 N Wolfe St, 5th floor, Baltimore, MD 21205, USA. Tel: +1 410 614 6088; e-mail:

Received 19 December, 2014

Revised 18 March, 2015

Accepted 20 March, 2015

Copyright © 2015 Wolters Kluwer Health, Inc.