TY - JOUR
T1 - Long-term Hepatitis B and Liver Outcomes Among Adults Taking Tenofovir-Containing Antiretroviral Therapy for HBV/HIV Coinfection in Zambia
AU - IeDEA Southern Africa
AU - Vinikoor, Michael J.
AU - Hamusonde, Kalongo
AU - Muula, Guy
AU - Asombang, Mah
AU - Riebensahm, Carlotta
AU - Chitundu, Helen
AU - Sunkuntu-Sichizya, Veronica
AU - Bhattacharya, Debika
AU - Sinkala, Edford
AU - Lauer, Georg
AU - Chung, Raymond
AU - Mbewe, Wilson
AU - Egger, Matthias
AU - Bosomprah, Samuel
AU - Wandeler, Gilles
N1 - Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved.
PY - 2024/6/15
Y1 - 2024/6/15
N2 - Background. Long-term outcomes of tenofovir-containing antiretroviral therapy (ART) for hepatitis B virus (HBV)/human immunodeficiency virus (HIV) coinfection were evaluated in Zambia. Methods. A prospective cohort of adults with HIV and hepatitis B surface antigen (HBsAg)-positivity was enrolled at ART initiation. On tenofovir-containing ART, we ascertained HBV viral load (VL) non-suppression, alanine aminotransferase (ALT) elevation, serologic end-points, progression of liver fibrosis based on elastography, and hepatocellular carcinoma (HCC) incidence. We also described a subgroup (low HBV VL and no/minimal fibrosis at baseline) that, under current international guidelines, would not have been treated in the absence of their HIV infection. Results. Among 289 participants at ART start, median age was 34 years, 40.1% were women, median CD4 count was 191 cells/ mm3, 44.2% were hepatitis B e antigen-positive, and 28.4% had liver fibrosis/cirrhosis. Over median 5.91 years of ART, 13.6% developed HBV viral non-suppression, which was associated with advanced HIV disease. ALT elevation on ART was linked with HBV VL non-suppression. Regression of fibrosis and cirrhosis were common, progression to cirrhosis was absent, and no cases of HCC were ascertained. HBsAg seroclearance was 9.4% at 2 and 15.4% at 5 years, with higher rates among patients with low baseline HBV replication markers. Conclusions. Reassuring long-term liver outcomes were ascertained during tenofovir-based ART for HBV/HIV coinfection in Zambia. Higher than expected HBsAg seroclearance during ART underscores the need to include people with HIV in HBV cure research.
AB - Background. Long-term outcomes of tenofovir-containing antiretroviral therapy (ART) for hepatitis B virus (HBV)/human immunodeficiency virus (HIV) coinfection were evaluated in Zambia. Methods. A prospective cohort of adults with HIV and hepatitis B surface antigen (HBsAg)-positivity was enrolled at ART initiation. On tenofovir-containing ART, we ascertained HBV viral load (VL) non-suppression, alanine aminotransferase (ALT) elevation, serologic end-points, progression of liver fibrosis based on elastography, and hepatocellular carcinoma (HCC) incidence. We also described a subgroup (low HBV VL and no/minimal fibrosis at baseline) that, under current international guidelines, would not have been treated in the absence of their HIV infection. Results. Among 289 participants at ART start, median age was 34 years, 40.1% were women, median CD4 count was 191 cells/ mm3, 44.2% were hepatitis B e antigen-positive, and 28.4% had liver fibrosis/cirrhosis. Over median 5.91 years of ART, 13.6% developed HBV viral non-suppression, which was associated with advanced HIV disease. ALT elevation on ART was linked with HBV VL non-suppression. Regression of fibrosis and cirrhosis were common, progression to cirrhosis was absent, and no cases of HCC were ascertained. HBsAg seroclearance was 9.4% at 2 and 15.4% at 5 years, with higher rates among patients with low baseline HBV replication markers. Conclusions. Reassuring long-term liver outcomes were ascertained during tenofovir-based ART for HBV/HIV coinfection in Zambia. Higher than expected HBsAg seroclearance during ART underscores the need to include people with HIV in HBV cure research.
KW - antiviral therapy
KW - hepatitis B
KW - hepatocellular carcinoma
KW - HIV/AIDS
KW - liver fibrosis
UR - http://www.scopus.com/inward/record.url?scp=85196269927&partnerID=8YFLogxK
U2 - 10.1093/cid/ciad654
DO - 10.1093/cid/ciad654
M3 - Article
C2 - 37997691
AN - SCOPUS:85196269927
SN - 1058-4838
VL - 78
SP - 1583
EP - 1590
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -