Sunday, July 28, 2013

Suppression of HBV by Tenofovir in HBV/HIV Coinfected Patients: A Systematic Review and Meta-Analysis


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.

Alan Franciscus Editor-in-Chief, HBV Advocate

Abstract: Suppression of HBV by Tenofovir in HBV/HIV Coinfected Patients: A Systematic Review and Meta-Analysis.

Source
Research Department of Infection and Population Health, University College London, London, United Kingdom.
BACKGROUND:
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.
METHODS:
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 and/or emtricitabine.
RESULTS:
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.
INTERPRETATION:
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 TDF alone

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