The study below sought
to answer an important question about long-term suppression of the hepatitis B
virus in people who are coinfected with HIV.
The authors reviewed 23 studies that included 550 HIV/HBV coinfected
patients to find out if tenofovir treatment effectively suppressed HBV
infection without the development of resistance. The authors concluded that
tenofovir suppressed HBV without the addition of or co-administration with the HIV
medications lamivudine and/or emtricitabine.
The entire study is available on-line PLoS One.
PLoS One. 2013 Jul 10;8(7):e68152. doi:
10.1371/journal.pone.0068152. Print 2013.
Editor-in-Chief, HBV Advocate
Abstract: Suppression of HBV by
Tenofovir in HBV/HIV Coinfected Patients: A Systematic Review and
Price H, Dunn D, Pillay D, Bani-Sadr F, de Vries-Sluijs T, Jain MK, Kuzushita N, Mauss S, Núñez M, Nüesch R, Peters M, Reiberger T, Stephan C, Tan L, Gilson R.
Research Department of Infection and Population Health, University
College London, London, United Kingdom.
Hepatitis B coinfection
is common in HIV-positive individuals and as antiretroviral therapy has made
death due to AIDS less common, hepatitis has become increasingly important.
Several drugs are available to treat hepatitis B. The most potent and the one
with the lowest risk of resistance appears to be tenofovir (TDF). However there
are several questions that remain unanswered regarding the use of TDF,
including the proportion of patients that achieves suppression of HBV viral
load and over what time, whether suppression is durable and whether prior
treatment with other HBV-active drugs such as lamivudine, compromises the
efficacy of TDF due to possible selection of resistant HBV strains.
A systematic review and
meta-analysis following PRISMA guidelines and using multilevel mixed effects
logistic regression, stratified by prior and/or concomitant use of lamivudine
Data was available from
23 studies including 550 HBV/HIV coinfected patients treated with TDF. Follow
up was for up to seven years but to ensure sufficient power the data analyses
were limited to three years. The overall proportion achieving suppression of
HBV replication was 57.4%, 79.0% and 85.6% at one, two and three years,
respectively. No effect of prior or concomitant 3TC/FTC was shown. Virological
rebound on TDF treatment was rare.
TDF suppresses HBV to
undetectable levels in the majority of HBV/HIV coinfected patients with the
proportion fully suppressed continuing to increase during continuous treatment.
Prior treatment with 3TC/FTC does not compromise efficacy of TDF treatment. The
use of combination treatment with 3TC/FTC offers no significant benefit over
Labels: emtricitabine, HIV/HBV coinfection, lamivudine, long-term suppression, tenofovir, treatment response