The treatment dynamics assessment among patients with chronic viral hepatitis B, infected with human immunodeficiency virus
KeywordsCHB/HIV coinfection, quantitative determination of HBsAg (qHBsAg), HBV DNA, CD4 , ΔCD4 , “ALT flare”, hardly active antiretroviral therapy (HAART)
Introduction: the article represents prospective study results of the treatment dynamics among patients with chronic viral hepatitis B, infected with human immunodeficiency virus. Particularly, the role of qHBsAg dynamics in the serum concerning CHB treatment effectiveness of CHB/HIV coinfected patients as well as clinical and laboratory factors influencing on this marker.
The study purpose: To assess treatment dynamics of CHB/HIV coinfected patients basing on quantitative HBsAg determination and other clinical and laboratory test applying.
Material and methods: 60 coinfected patients were examined – the main group, 60 CHB monoinfected patients – comparison group to reach established study purpose. Diagnosis of HIV and chronic hepatitis B were verified. A clinical, laboratory, serological, molecular-genetic methods were used. Statistical processing of results was held with applying parametric and nonparametric methods for the data analysis.
Research results: There was a slight increase by 1.10 times in serum ALT in “a period of ≤ 6 months of antiviral therapy” with a subsequent decrease by 1.20-1.46 times in “a period of ˃ 6 months of therapy”. There was a decrease in the serum qHBsAg of coinfected patients in accordance with the duration of therapy by 1.56-21.10 times, and in case of the presence of "ALT flare" by 1.31-72.72 times. The greatest decrease in serum qHBsAg by 1.63-42.00 times during HAART was also observed in patients with an initial CD4 + count <350 cells / μl. A serum qHBsAg was 11.24 times lower after ˃ 12 months of therapy in the group of CHB/HIV coinfected patients with ΔCD4 + ˃100 cells / μl compared with the group of patients with ΔCD4 + 0 - 100 cells / μl.
Conclusions: A serum qHBsAg possibly to be decreased by 2 log10 among CHB/HIV coinfected patients after starting HAART with dual activity against HBV and HIV which includes nucleoside reverse transcriptase analogs (Tenofovir Disoproxil Fumarate (TDF) and lamivudine (3TC)). Defined main influencing factors on qHBsAg decreasing included: “ALT flare”, CD4+ count, ΔCD4+ as a result of monofactorial analysis. It is necessary to conduct further multifactorial analysis to determine complex of factors which could influence on further HBsAg by 2 log10 and HBsAg clearance.
On approval of the new Clinical Protocol on the use of antiretroviral drugs for the treatment and prevention of HIV infection: Order of the Ministry of Health of Ukraine. 2019. № 1292. Access mode: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-05062019--1292-pro-zatverdzhennja-novogo-klinichnogo-protokolu-iz-zastosuvannja-antiretrovirusnih-preparativ-dlja-likuvannja-ta-profilaktiki-vil-infekcii (Accessed:20.09.2020).
Avihingsanon A., Matthews G. V., Lewin S. R., et al. Assessment of HBV flare in a randomized clinical trial in HIV/HBV coinfected subjects initiating HBV-active antiretroviral therapy in Thailand. AIDS Res. Ther. 2012. 9:6. – URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324378/pdf/1742-6405-9-6.pdf (Accessed: 02.09..2020).
Brunetto M. at al. Characterization of serologic responses following ALT flares in >3000 CHB patients pooled from 5 clinical trials. ILC-2020 – abstract book (AS093). Journal of Hepatology 2020. Vol. 73. S58–S98. – URL: https://ilc-congress.eu/wp-content/uploads/2020/08/digital-ilc-2020-abstract-book-20-august.pdf (Accessed: 02.09..2020).
Chang M. L., Liaw Y. F. Hepatitis B flares in chronic hepatitis B: pathogenesis, natural course, and management. J. Hepatol. 2014. Vol. 61. P.1407-1417.
Global hepatitis report, 2017 / WHO. 2017. 83 p. http://apps.who.int/iris/bitstream/handle/10665/255016/9789?sequence=1 (Accessed: 02.09.2020).
Hall S. at al. A prospective study of nucleot(s)ide analogue discontinuation in non-cirrhotic HBeAg-negative chronic hepatitis B patients: interim analysis at week 48 demonstrates profound reductions of HBsAg associated with ALT flare. ILC-2020 – abstract book (AS095). Journal of Hepatology 2020. Vol. S58–S98. – URL: https://ilc-congress.eu/wp-content/uploads/2020/08/digital-ilc-2020-abstract-book-20-august.pdf (Accessed: 02.09.2020).
Gantner P. Higher rates of HBsAg clearance with tenofovir-containing therapy in HBV/HIV coinfection. PLoS One. 2019. Vol. 14, № 4. P. 1–12. doi: 10.1371/journal.pone.0215464. eCollection 2019.
Kosi L., Reiberger T., Payer B. A., et al. Five-year on-treatment efficacy of lamivudine-, tenofovir- and tenofovir + emtricitabine-based HAART in HBV-HIV-coinfected patients. J. Viral. Hepat. 2012. Vol. 19. P. 801–810.
Mamta J. at al. Incidence and predictors of hepatitis B surface antigen clearance among people living with HIV and hepatitis B. ILC-2020 – abstract book (FRI392). Journal of Hepatology 2020. Vol. 73. S401–S652. – URL: https://ilc-congress.eu/wp-content/uploads/2020/08/digital-ilc-2020-abstract-book-20-august.pdf (Accessed: 02.09.2020).
Panel on Opportunistic Infections in Adults and Adolescents with HIV : Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV / recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America, 2020. 450 p. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. (Accessed: 02.09.2020).
Rowley M. W., Patel A., Zhou W., Wong M., Seetharam A. B. Immune Reconstitution Syndrome with Initiation of Treatment of HBV/HIV Co-infection: Activity Flare associated with E antigen Seroconversion. Ann. Hepatol. 2019. Vol. 18. P. 220-224.
Singh K. P., Crane M., Audsley J., Avihingsanon A., Sasadeusz J., Lewin S.R.. HIV-hepatitis B virus coinfection: epidemiology, pathogenesis, and treatment. AIDS. 2017. Vol. 31. P. 2035-2052.
Wong D., Littlejohn M., Edwards R., et al. ALT flares during nucleotide analogue therapy are associated with HBsAg loss in genotype A HBeAg-positive chronic hepatitis B. Liver. Int. 2018. Vol. 38. P.1760-1769.
Yang R., Gui X., Ke H., Xiong Y., Gao S. Long-term observation on hepatitis B surface antigen seroclearance in therapy experienced HIV/HBV co-infected Chinese. J. Viral. Hepat. 2020. Vol. 27. P.127 – 134.
Yoshio S. et all. Impact of hepatitis B virus-related immune reconstitution inflammatory syndrome on HBsAg loss in patients co-infected with human immunodeficiency virus. ILC-2020 – abstract book (FRI405). Journal of Hepatology 2020. Vol. 73. S401–S652. – URL: https://ilc-congress.eu/wp-content/uploads/2020/08/digital-ilc-2020-abstract-book-20-august.pdf (Accessed: 02.09.2020).
Yoshikawa S. Impact of Immune Reconstitution-induced Hepatic Flare on HBsAg Loss in HBV/HIV-1-Coinfected Patients. J. Infect. Dis. 2020. doi: 10.1093/infdis/jiaa662. Online ahead of print.
How to Cite
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Number of views and downloads: 222
Number of citations: 0