Liver fibrosis by transient elastography and virologic outcomes after introduction of tenofovir in lamivudine-experienced adults with HIV and hepatitis B virus (HBV) co-infection in Ghana



Stockdale, Alexander ORCID: 0000-0002-5828-3328, Phillips, RO, Beloukas, Apostolos ORCID: 0000-0001-5639-0528, Appiah, LT, Chadwick, D, Bhagani, S, Bonnett, Laura ORCID: 0000-0002-6981-9212, Sarfo, FS, Dusheiko, G and Geretti, Anna ORCID: 0000-0002-3670-6588
(2015) Liver fibrosis by transient elastography and virologic outcomes after introduction of tenofovir in lamivudine-experienced adults with HIV and hepatitis B virus (HBV) co-infection in Ghana. Clinical Infectious Diseases, 61 (6). 883 - 891.

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Abstract

Background Antiretroviral treatment (ART) programs in sub-Saharan Africa have for many years included lamivudine as the sole 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 HIV-HBV co-infected subjects maintained on lamivudine, and 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-1 and HBV replication. Results After median 45 months of lamivudine, HIV-1 RNA and HBV DNA were detectable in 35/106 (33.0%) and 54/106 (50.9%) subjects respectively, with corresponding drug-resistance rates of 17/106 (16.0%) and 31/106 (29.2%). TE values were median 5.7 kPa (IQR 4.7, 7.2) and independently associated with HBV DNA load, AST levels, and platelet counts; 13/106 (12.3%) subjects had TE measurements >9.4 kPa. Twelve months after the first assessment, and median 7.8 months after introducing tenofovir, HBV DNA levels declined by mean 1.5 log10 IU/ml (p2000 IU/ml (mean -0.8 kPa; p=0.048) or TE values >7.6 kPa (mean -1.2 kPa; p=0.021). HIV-1 RNA detection rates remained unchanged. Conclusions A proportion of HIV/HBV co-infected 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.

Item Type: Article
Uncontrolled Keywords: hepatitis B, lamivudine, tenofovir, transient elastography, Africa
Depositing User: Symplectic Admin
Date Deposited: 01 Jun 2015 16:05
Last Modified: 04 Dec 2020 09:16
DOI: 10.1093/cid/civ421
Open Access URL: https://academic.oup.com/cid/article/61/6/883/4513...
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URI: http://livrepository.liverpool.ac.uk/id/eprint/2012421