Obstacles to HBV functional cure: Late presentation in HIV and its impact on HBV seroconversion in HIV/HBV coinfection.
Kathrin Van BremenChristian HoffmannStefan MaussThomas LutzPatrick IngilizChristoph D SpinnerStefan ScholtenCarolynne Schwarze-ZanderFlorian BergerSven BreitschwerdtStephan SchneeweissFabian BuschJan-Christian WasmuthGerd FätkenheuerClara LehmannJürgen K RockstrohChristoph BoeseckePublished in: Liver international : official journal of the International Association for the Study of the Liver (2020)
Several cohorts have shown that long-term tenofovir-containing combination antiretroviral therapy (cART) leads to higher HBsAg seroclearance rates in HIV/HBV coinfected patients vs HBV-monoinfected patients under tenofovir disoproxil fumarate (TDF)-based therapy. We have analysed data on determinants of HBsAg loss in a retrospective multicentric cohort of 359 HIV/HBV coinfected patients. Median CD4 T-cell count at baseline was 359/ul (321-404), CDC stage was C in 20% (n = 70). Most patients (68%) were ART-naïve when TDF- or tenofovir alafenamide (TAF)-containing cART was initiated (baseline). After a median follow-up of 11 years HBsAg loss had occurred in 66/359 (18%) patients. However, patients with stage CDC C (P ≤ .001), lower CD4 gain (P = .043) and not receiving TDF/FTC (P = .008) were less likely to lose HBsAg. Long-term TDF-containing cART appears to achieve higher rates of HBsAg seroclearance compared to published data for HBV monoinfected subjects. However, late presentation for HIV and poor immune recovery significantly impair HBV seroconversion rates.
Keyphrases
- antiretroviral therapy
- hepatitis b virus
- end stage renal disease
- hiv infected
- hiv positive
- human immunodeficiency virus
- newly diagnosed
- chronic kidney disease
- ejection fraction
- hiv aids
- hepatitis c virus
- hiv infected patients
- bone marrow
- mesenchymal stem cells
- patient reported outcomes
- machine learning
- cell proliferation
- systematic review
- big data
- deep learning
- cell cycle
- replacement therapy
- herpes simplex virus