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|Title: ||Liver Fibrosis by Transient Elastography and Virologic Outcomes After Introduction of Tenofovir in Lamivudine-Experienced Adults With HIV and Hepatitis B Virus Coinfection in Ghana|
|Authors: ||Stockdale, Alexander J.|
Phillips, Richard O.
Appiah, Lambert Tetteh
|Keywords: ||hepatitis B; lamivudine; tenofovir; transient elastography; Africa.|
|Issue Date: ||28-May-2015|
|Publisher: ||Oxford University Press|
|Citation: ||Oxford University Press|
|Abstract: ||Background. Antiretroviral treatment (ART) programs in sub-Saharan Africa have for many years included
lamivudine as the sole hepatitis B virus (HBV) inhibitor. Long-term outcomes and the effects of introducing tenofovir
as part of ART in these populations have not been characterized.
Methods. The study comprised a cross-sectional analysis of 106 human immunodeficiency virus (HIV)/HBV–
coinfected subjects maintained on lamivudine, as well as a prospective analysis of 76 lamivudine-experienced subjects
who introduced tenofovir. Patients underwent assessment of liver fibrosis by transient elastography (TE) and
testing to characterize HIV type 1 (HIV-1) and HBV replication.
Results. After a median of 45 months of lamivudine treatment, HIV-1 RNA and HBV DNA were detectable in
35 of 106 (33.0%) and 54 of 106 (50.9%) subjects, respectively, with corresponding drug resistance rates of 17 of 106
(16.0%) and 31 of 106 (29.2%), respectively. Median TE values were 5.7 kPa (interquartile range, 4.7–7.2 kPa) and
independently associated with HBV DNA load, aspartate aminotransferase levels, and platelet counts; 13 of 106
(12.3%) subjects had TE measurements >9.4 kPa. Twelve months after the first assessment, and a median of 7.8
months after introducing tenofovir, HBV DNA levels declined by a mean of 1.5 log10 IU/mL (P < .001). TE values
changed by a mean of −0.2 kPa (P = .097), and declined significantly in subjects who had pretenofovir HBV DNA
levels >2000 IU/mL (mean, −0.8 kPa; P = .048) or TE values >7.6 kPa (mean, −1.2 kPa; P = .021). HIV-1 RNA detection
rates remained unchanged.
Conclusions. A proportion of HIV/HBV-coinfected patients on long-term lamivudine-containing ART had
poor HIV and HBV suppression, drug resistance, and TE values indicative of advanced liver fibrosis. Tenofovir improved
HBV control and reduced liver stiffness in subjects with high HBV DNA load and TE values.|
|Description: ||An article published by Oxford University Press|
|Appears in Collections:||College of Health Sciences|
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