Longer HAART Use Predicts Hepatitis B Clearance

Longer HAART Use Predicts Hepatitis B Clearance
By Michael Smith, North American Correspondent, MedPage Today
Published: July 15, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
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TORONTO, July 15 -- In patients with both HIV and hepatitis B, prolonged use of drugs active against both viruses improves the odds of clearing the hepatitis, researchers said.
Action Points

■Note that this study found that longer use of antiretrovirals that are also active against hepatitis B increased the odds of clearing the infection.
In a retrospective, longitudinal study, patients who were on such highly active antiretroviral therapy (HAART) for a longer period had nearly three times the likelihood of clearing the HBeAg antigen associated with active hepatitis B, according to Marina Núñez, MD, PhD, and a colleague at Wake Forest University School of Medicine in Winston-Salem, N.C.


Those patients also had a 54% improvement in the chance of clearing the so-called surface antigen -- HBsAg -- the researchers said in the May/June issue of HIV Clinical Trials.


In addition, the researchers found that patients with higher levels of alanine aminotransferase at baseline were at a higher risk of being diagnosed with cirrhosis within a few years.


"One of the most interesting findings was the confirmation that a simple marker, such as transaminase levels before treatment, is useful in identifying patients at higher risk of developing (hepatitis B-related) complications in a few years," Dr. Núñez said in a statement.


The researchers looked at medical records of 72 patients treated at Wake Forest University Baptist Medical Center between 1990 and 2008 who had both HIV and hepatitis B.


During follow-up, 64 (or 88.9%) of the patients had HAART containing drugs active against hepatitis B, including tenofovir (Viread), lamivudine (3TC), or emtricitabine (Emtriva).


Most patients took at least two active drugs during follow-up, but 11.1% took only one antiretroviral with hepatitis B activity.


Six out of 34 patients positive for HBeAg (or 17.6%) cleared the antigen, the researchers found. The only factor that was associated with HBeAg clearance was long use of the medications.


For those who cleared the antigen, the average use of antihepatitis medications was 4.0 years, compared with 1.7 for those who did not. The difference yielded an odds ratio of 2.66, with a 95% confidence interval from 1.15 to 6.16, which was significant at P=0.02.


And 5.5% of the patients cleared the HBsAg antigen. Again the only factor predicting clearance was longer use of hepatitis B-active HAART.


For those who cleared the antigen, average time on the drugs was 4.25 years, compared with 1.676 for the others, yielding an odds ratio of 1.54, with a 95% confidence interval from 1.02 to 2.31, which was significant at P=0.04.


Finally, higher alanine aminotransferase levels before HAART initiation were associated with the diagnosis of cirrhosis during follow-up -- the odds ratio was 1.02, with a 95% confidence interval from 1.002 to 1.03, which was significant at P=0.02.


The findings "stress the importance of good control of the HIV and (hepatitis B) infections," Dr. Núñez said.


In patients with elevated liver enzymes, "it is even more important to control the (hepatitis B) infection in an attempt to decrease the risks of complications," she said. "Those patients should also be more closely screened for liver complications."


The study had a number of limitations including its retrospective nature, small sample size, predominantly African-American male population, late diagnosis of HIV, indeterminant duration of hepatitis B infection, and radiologic rather than histologic diagnosis of cirrhosis.




The study was supported by the 2008 Medical Student Summer Research Training Program, supported through grants from the NIH Health, Wake Forest University School of Medicine Departments, Centers, and Institutes, and private gifts.
The researchers made no disclosures.



Primary source: HIV Clinical Trials
Source reference:
Lee, T Núñez, M "Longer duration of HBV-active antiretroviral therapy is linked to favorable virological outcome in HIV-HBV co-infected patients" HIV Clin Trials 2009; 10 (3).