Liver Fibrosis Regression and Progression During Controlled Hepatitis B Virus Infection Among HIV-HBV Patients Treated with Tenofovir Disoproxil Fumarate in France: a Prospective Cohort Study

Overview

Journal J Int AIDS Soc

Specialty Infectious Diseases

Date 2017 Apr 1

PMID 28362068

Citations 26

Authors

Anders Boyd

Julie Bottero

Patrick Miailhes

Caroline Lascoux-Combe

Hayette Rougier

Pierre-Marie Girard

Lawrence Serfaty

Karine Lacombe

Affiliations

Soon will be listed here.

Abstract

Introduction: Long-term tenofovir disoproxil fumarate (TDF) use has been associated with significant regression of liver fibrosis during hepatitis B virus (HBV) mono-infection, yet little is known during HIV-HBV coinfection. The aim of this study was to evaluate the evolution of liver fibrosis and its determinants in TDF-treated coinfected patients.

Methods: In this prospective cohort study, 167 HIV-HBV-infected patients initiating TDF-containing antiretroviral therapy were included. Fibrosis was assessed using the FibroTest® at baseline and every six to twelve months. Risk factors for fibrosis progression (F0-F1-F2 to F3-F4) and regression (F3-F4 to F0-F1-F2) were evaluated.

Results: At baseline, 134 (80.2%) patients had detectable HBV-DNA (median = 4.93 log IU/mL, IQR = 2.94-7.15) and 104 (62.3%) had hepatitis B "e" antigen-positive serology. Median follow-up was sixty months (IQR = 36-93). In the 47 (28.1%) patients with F3-F4 baseline fibrosis, 7/47 (14.9%) regressed to F0-F1-F2 at last follow-up visit. Fibrosis regression was significantly associated with higher CD4+ cell counts (= 0.009) and lower fasting triglyceride levels (= 0.007) at TDF-initiation. In the 120 (71.9%) patients with F0-F1-F2-baseline fibrosis, 20/120 (16.7%) progressed to F3-F4 at last follow-up visit. Fibrosis progression was associated with male gender (= 0.01), older age (= 0.001), from low/moderate HBV-endemic country (= 0.007), lower nadir CD4+ cell count (= 0.03), higher fasting glycaemia (= 0.03) and anaemia (= 0.004) at TDF-initiation. Control of HBV replication at end of follow-up was extensive (88.1%), while no HBV-related factors emerged as predictors of progression/regression. Incidence of severe liver-related events was low (= 4, rate = 0.5/100 person-years).

Conclusion: Liver fibrosis levels are stable for most coinfected patients undergoing TDF, despite control of HBV replication. Nevertheless, a concerning amount of liver fibrosis progression did occur, which could be partly explained by metabolic abnormalities and past severe immunosuppression and requires further evaluation.

Citing Articles

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