Incidence and Risk Factors for Incomplete HBV DNA Suppression in HIV/HBV-Coinfected Patients Initiating Tenofovir-Based Therapy

摘要

Suppression of hepatitis B virus (HBV) DNA to undetectable levels is an important goal for HIV/HBV-coinfected patients receiving anti-HBV-active antiretroviral therapy (ART), and current guidelines recommend that this outcome should be reached by one year of treatment. However, the proportion of patients that fail to achieve an undetectable HBV DNA at this time point and its determinants remain unknown in clinical practice. The objective of this study was to determine the incidence and risk factors for incomplete HBV suppression following one year of tenofovir-based ART. We performed a cohort study among tenofovir-treated HIV/HBV-coinfected patients. Patients had HBV viremia, initiated tenofovir-based ART, and had HBV DNA measured at one year of therapy. The primary outcome was incomplete HBV suppression (HBV DNA ≥2.6 log IU/mL) at one year. Logistic regression determined odds ratio (ORs) of incomplete HBV suppression for risk factors of interest. Among 133 patients, 54% (95% CI, 46%–63%) had incomplete HBV suppression at one year. Incomplete suppression was associated with higher baseline HBV DNA (OR, 1.46 per log IU/mL increase; 95% CI, 1.1–1.94) and detectable HIV viremia at one year (OR, 2.52; 95% CI, 1.19–5.32). Among 66 patients with suppressed HIV RNA at one year, 28 (42%) failed to achieve an undetectable HBV DNA. Failure to suppress HBV DNA by one year occurred in a sizeable proportion of tenofovir-treated HIV/HBV-coinfected patients. Higher HBV DNA and detectable HIV viremia were risk factors for incomplete HBV suppression.