Persistent HBV replication and serological response during up to 15 years of tenofovir-based antiretroviral therapy in HIV/HBV-coinfected patients: A multicentre prospective cohort study

Lorenza N.C. Dezanet, Patrick Miailhes, Caroline Lascoux-Combe, Julie Chas, Sarah Maylin, Audrey Gabassi, Hayette Rougier, Constance Delaugerre, Karine Lacombe, Anders Boyd

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Abstract

Objectives: To determine the extent of hepatitis B virus (HBV) suppression and its association with seroclearance of hepatitis 'e' antigen (HBeAg) and hepatitis B surface antigen (HBsAg) in HIV/HBV-coinfected patients undergoing long-term tenofovir-based antiretroviral therapy (ART). Methods: We prospectively followed 165 HIV/HBV-coinfected patients undergoing tenofovir-based ART. Serum HBV-DNA viral loads and HBeAg and HBsAg status were obtained at tenofovir initiation and every 6-12 months. We calculated the proportion achieving virological response (VR, <60 IU/mL) during follow-up. We also calculated rates of HBeAg- and HBsAg-seroclearance, which were compared between those who achieved versus never achieved VR during follow-up using an Exact binomial test. Results: During a median 8.1 years (IQR=4.0-13.2) of tenofovir treatment, 152 (92.1%) patients were able to achieve VR and 13 (7.9%) never achieved VR (median HBV-DNA at the end of follow-up=608 IU/mL, range=67-52400000). The prevalence of individuals with detectable HBV-DNA (≥60 IU/mL) decreased during tenofovir treatment: 15.1% (n=14/93) at 5 years, 3.2% (n=2/62) at 10 years and, 3.2% (n=1/31) at 15 years. 44/96 HBeAg-positive patients (6.15/100 person-years) had HBeAg-seroclearance and 13/165 patients overall (0.87/100 person-years) had HBsAg-seroclearance. No difference in HBeAg-seroclearance was observed between those who achieved versus never achieved VR (7.4 versus 3.7/100 person-years, P=0.33), while HBsAg-seroclearance was only observed in those with VR (1.0 versus 0/100 person-years, P=0.49; respectively). Individuals with VR also had a higher frequency of undetectable HIV-RNA during treatment (P<0.001). Conclusions: During long-term tenofovir-based ART for HIV/HBV coinfection, persistent HBV viraemia is apparent, but becomes less frequent over time. HBsAg-seroclearance only occurred in those with full HBV and relatively high HIV suppression.

Original languageEnglish
Pages (from-to)3009-3019
Number of pages11
JournalJournal of antimicrobial chemotherapy
Volume76
Issue number11
DOIs
Publication statusPublished - 1 Nov 2021

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