Study On Virology And Immunology Of HBV In Patients With HIV / HBV Co - Infection

[Objective] Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) share the same routes of transmission, and liver diseases are a major cause of death in HIV patients. Currently there is a lack of evidence regarding virological, biochemical and immunological responses to different regimens against HBV in the settings of HIV/HBV co-infection.[Methods] We retrieved information from our multicenter cohort database and outpatient database, and measured HBV DNA, antigen quantification and interleukin-18 (IL-18) prior to antiretroviral therapy, at week 24 and at week 48. In this study, we had two treatment groups:subjects receiving lamivudine (3TC) as the only HBV-active medication in combination antiretroviral therapy (cART) were designated as 3TC monotherapy group, while subjects receiving tenofovir (TDF)+3TC based cART were designated as TDF dual therapy group.[Results] We enrolled 151 subjects, with 60 in 3TC monotherapy group and 91 in TDF+3TC group. Among them,45.7% had baseline HBV DNA>20000 IU/ml. After one year of treatment, HBV suppression rates were 96.8% and 98.0% in 3TC and TDF groups, respectively (P>0.999) when baseline HBV DNA was below 20000IU/ml; while suppression rates were 34.5% in 3TC group and 72.5% in TDF group (P=0.002) when baseline HBV DNA was above 20000IU/ml. Two group had similar rates of HBsAg decline, while TDF group had more prominent HBeAg decline. During the one-year treatment, ten subjects experienced HBeAg seroconversion (28.6%,10/35), and five had HBsAg loss (3.6%,5/137). In multivariate regression, HBV viral suppression was significantly associated with HBeAg seroconversion. Both 3TC and TDF+3TC regimens had similar biochemical responses, while IL-18 reduction was only observed in TDF group, in patients with HBV viral suppression after one year’s treatment.[Conclusions] In this study, we bring about a "stratification strategy":in patients with baseline HBV DNA<20000IU/ml,3TC and TDF+3TC groups had similar HBV suppression rates; while TDF+3TC was superior to 3TC when baseline HBV DNA was >20000IU/ml. These results will potentially provide further guidance to HBV treatment in the settings of HIV/HBV coinfection.