Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected patients following antiretroviral therapy interruption

Gregory J. Dore, Vicente Soriano, Jürgen Rockstroh, Bernd Kupfer, Ellen Tedaldi, Lars Peters, Jacqueline Neuhaus, Massimo Puoti, Marina B. Klein, Amanda Mocroft, Bonaventura Clotet, Jens D. Lundgren

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Background: The impact of antiretroviral therapy (ART) interruption in HIV-hepatitis B virus (HBV)-coinfected patients was examined in the Strategic Management of AntiRetroviral Therapy (SMART) study. Methods: Plasma HBV DNA was measured in all hepatitis B surface antigen-positive (HBV-positive) participants at baseline, and at months 1, 2, 4, 6, 8, 10, and 12. Results: Among HBV-positive participants in the ART interruption (drug conservation) (n = 72) and ART continuation (virological suppression) (n = 62) arms, HBV DNA rebound of more than 1 log from baseline at months 1-4 was seen in 31-33% (P = 0.003) and 3-4% (P = 0.017), respectively. Thirteen HBV-positive participants had HBV DNA rebound of more than 3 log, including 12 in the drug conservation arm, of which eight were on tenofovir-containing regimens. Factors independently associated with a HBV DNA rebound were drug conservation arm (P = 0.0002), nondetectable HBV DNA at baseline (P = 0.007), and black race (P = 0.03). Time to ART reinitiation was shorter (7.5, 15.6, and 17.8 months; P < 0.0001) and proportion reinitiating greater (62.5, 46.5, and 39.7%; P = 0.0002) among HBV-positive participants as compared with hepatitis C virus-positive and non-HBV/hepatitis C virus participants in the drug conservation arm. No hepatic decompensation events occurred among HBV-positive participants in either arm. Conclusion: HBV DNA rebound following ART interruption is common and may be associated with accelerated immune deficiency in HIV-HBV-coinfected patients.

Original languageEnglish (US)
Pages (from-to)857-865
Number of pages9
JournalAIDS
Volume24
Issue number6
DOIs
StatePublished - Mar 2010

Keywords

  • Antiretroviral therapy
  • Coinfection
  • HIV
  • Hepatitis B virus
  • Tenofovir

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