Hepatitis B Virus (HBV) Infection and Re-activation During Nucleos(t)ide Reverse Transcriptase Inhibitor-Sparing Antiretroviral Therapy in a High-HBV Endemicity Setting



Abdullahi, Adam ORCID: 0000-0001-9703-8264, Fopoussi, Olga Mafotsing, Torimiro, Judith, Atkins, Mark, Kouanfack, Charles and Geretti, Anna Maria ORCID: 0000-0002-3670-6588
(2018) Hepatitis B Virus (HBV) Infection and Re-activation During Nucleos(t)ide Reverse Transcriptase Inhibitor-Sparing Antiretroviral Therapy in a High-HBV Endemicity Setting. OPEN FORUM INFECTIOUS DISEASES, 5 (10). ofy251-.

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Abstract

<h4>Background</h4>We monitored the evolution of markers of hepatitis B virus (HBV) infection in virologically suppressed HIV-positive patients switching to nucleoside reverse transcriptase inhibitor (NRTI)-sparing antiretroviral therapy within a randomized trial in Cameroon.<h4>Methods</h4><b><i> </i></b> HBV surface antigen (HBsAg), HBV DNA, and antibodies against surface (anti-HBs), core (total anti-HBc), and e-antigen (anti-HBe) were measured retrospectively in samples collected at study entry and over 48 weeks after NRTI discontinuation.<h4>Results</h4>Participants (n = 80, 75% females) had a plasma HIV-1 RNA <60 copies/mL, a median CD4 count of 466 cells/mm<sup>3</sup>, and undetectable HBsAg and HBV DNA at study entry. After NRTI discontinuation, 3/20 (15.0%) anti-HBc-negative patients showed evidence indicative or suggestive of incident HBV infection (163 cases/1000 person-years); 6/60 (10.0%) anti-HBc-positive patients showed evidence indicative or suggestive of HBV reactivation (109 cases/1000 person-years). In one case of reactivation, anti-HBs increased from 14 to >1000 IU/L; sequencing showed HBV genotype A3 and 3 escape mutations in surface (Y100C, K122R, Y161FY). Alongside new-onset detection of HBsAg or HBV DNA, 1 patient experienced acute hepatitis and 6 patients experienced mild or marginal increases in serum transaminase levels.<h4>Conclusions</h4>Evolving treatment strategies for sub-Saharan Africa must be accompanied by the formulation and implementation of policy to guide appropriate assessment and management of HBV status.

Item Type: Article
Uncontrolled Keywords: hepatitis, lamivudine, mutants, simplification, tenofovir
Depositing User: Symplectic Admin
Date Deposited: 01 Nov 2018 14:33
Last Modified: 19 Jan 2023 01:13
DOI: 10.1093/ofid/ofy251
Open Access URL: https://doi.org/10.1093/ofid/ofy251
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3028277