HIV-HBV coinfection in Southern Africa and the effect of Lamivudine- Versus tenofovir-containing cART on HBV outcomes

Raph L. Hamers, Hans L. Zaaijer, Carole L. Wallis, Margaret Siwale, Prudence Ive, Mariette E. Botes, Kim C.E. Sigaloff, Andy I.M. Hoepelman, Wendy S. Stevens, Tobias F. Rinke De Wit

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)174-182
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume64
Issue number2
DOIs
Publication statusPublished - 1 Oct 2013

Cite this

Hamers, Raph L. ; Zaaijer, Hans L. ; Wallis, Carole L. ; Siwale, Margaret ; Ive, Prudence ; Botes, Mariette E. ; Sigaloff, Kim C.E. ; Hoepelman, Andy I.M. ; Stevens, Wendy S. ; Rinke De Wit, Tobias F. / HIV-HBV coinfection in Southern Africa and the effect of Lamivudine- Versus tenofovir-containing cART on HBV outcomes. In: Journal of Acquired Immune Deficiency Syndromes. 2013 ; Vol. 64, No. 2. pp. 174-182.
@article{315fdc5187174512a2e1daf1721e6ded,
title = "HIV-HBV coinfection in Southern Africa and the effect of Lamivudine- Versus tenofovir-containing cART on HBV outcomes",
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.",
keywords = "Antiretroviral therapy, Hepatitis B virus, HIV, Sub-Saharan Africa, Viral drug resistance",
author = "Hamers, {Raph L.} and Zaaijer, {Hans L.} and Wallis, {Carole L.} and Margaret Siwale and Prudence Ive and Botes, {Mariette E.} and Sigaloff, {Kim C.E.} and Hoepelman, {Andy I.M.} and Stevens, {Wendy S.} and {Rinke De Wit}, {Tobias F.}",
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doi = "10.1097/QAI.0b013e3182a60f7d",
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Hamers, RL, Zaaijer, HL, Wallis, CL, Siwale, M, Ive, P, Botes, ME, Sigaloff, KCE, Hoepelman, AIM, Stevens, WS & Rinke De Wit, TF 2013, 'HIV-HBV coinfection in Southern Africa and the effect of Lamivudine- Versus tenofovir-containing cART on HBV outcomes' Journal of Acquired Immune Deficiency Syndromes, vol. 64, no. 2, pp. 174-182. https://doi.org/10.1097/QAI.0b013e3182a60f7d

HIV-HBV coinfection in Southern Africa and the effect of Lamivudine- Versus tenofovir-containing cART on HBV outcomes. / Hamers, Raph L.; Zaaijer, Hans L.; Wallis, Carole L.; Siwale, Margaret; Ive, Prudence; Botes, Mariette E.; Sigaloff, Kim C.E.; Hoepelman, Andy I.M.; Stevens, Wendy S.; Rinke De Wit, Tobias F.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 64, No. 2, 01.10.2013, p. 174-182.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - HIV-HBV coinfection in Southern Africa and the effect of Lamivudine- Versus tenofovir-containing cART on HBV outcomes

AU - Hamers, Raph L.

AU - Zaaijer, Hans L.

AU - Wallis, Carole L.

AU - Siwale, Margaret

AU - Ive, Prudence

AU - Botes, Mariette E.

AU - Sigaloff, Kim C.E.

AU - Hoepelman, Andy I.M.

AU - Stevens, Wendy S.

AU - Rinke De Wit, Tobias F.

PY - 2013/10/1

Y1 - 2013/10/1

N2 - 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.

AB - 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.

KW - Antiretroviral therapy

KW - Hepatitis B virus

KW - HIV

KW - Sub-Saharan Africa

KW - Viral drug resistance

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U2 - 10.1097/QAI.0b013e3182a60f7d

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JO - Journal of acquired immune deficiency syndromes (1999)

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