Abstract

BACKGROUND: Combination emtricitabine (FTC) or lamivudine (LAM) with tenofovir (TDF) is the recommended first-line regime for treatment in chronic hepatitis B (HBV)/HIV co-infection. However, in those failing to suppress, few data exist regarding further management. In HBV/HIV co-infection there are no published data describing outcomes when ETV is then added to TDF based regimes in patients no longer suppressing their HBV.We report the first series of patients using ETV with Truvada® based highly active anti-retroviral therapy (HAART) in HBV/HIV co-infected patients with previous HBV therapy failure, including inadequate suppression.

METHODS: A prospective observational study.

RESULTS: 13 HIV/HBV co-infected patients (all male, hepatitis B e antigen positive, e Ab negative) were commenced on ETV in addition to background Truvada ®. All patients were previously exposed to LAM or FTC and TDF (median 53 months, range 6-123). 7 patients had LAM monotherapy prior to TDF/LAM or FTC combination; the remaining 6 patients were exposed to FTC or LAM and TDF combination. Median time of follow-up was 74 weeks (range 16-159), median HBV decline 2.53 log10 IU/mL (range 1.28-7.36). 38% of patients achieved undetectable HBV DNA level by the end of the study, 8/13 (62%) achieved normal alanine aminotransferase (ALT) levels with median reduction -28 u/L (range -152 to 37).TDF was stopped in one patient because of renal toxicity. ETV was well tolerated with no change of eGFR during the study.

CONCLUSION: Entecavir can be considered in addition to TDF/FTC in HBV/HIV co-infected treatment experience patients failing to fully suppress their HBV viral load.