Hepatitis B Clearance with Longer HAART

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

* Explain to interested patients that patients with both HIV and hepatitis B are at higher risk of liver complications.

* 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 identifyingpatients 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.