Impact of tenofovir on hepatitis delta replication in HIV-coinfected patients in the Swiss HIV Cohort Study. Clinical Infectious Diseases
Béguelin et al. assessed the impact of long-term Tenofovir Disoproxil Fumarat (TDF) therapy on hepatitis B virus (HBV) and hepatitis delta virus (HDV) replication in the Swiss HIV Cohort Study (SHCS). All SHCS participants with a positive Hepatitis B surface antigen (HBsAg) test between January 1988 and December 2014 were considered. Patients were followed for a median of 4.9 years on TDF.
Median HDV RNA was 7.0 log10 cp/ml before TDF initiation and 6.7 log10 cp/ml at the last follow-up visit. Sixteen of the 21 patients (76%) reached HBV suppression (2 log10 HDV RNA reduction during follow-up, and HDV RNA became undetectable in three of them (14.3%). No differences in HBV DNA levels, quantitative HBsAg, liver enzymes or HIV-1 related characteristics were noted between individuals with and without HDV RNA reduction during TDF treatment. HBsAg loss was only observed in one patient who initiated TDF with a very low baseline quantitative HBsAg. Two-thirds of patients had a positive anti-hepatitis C virus (HCV) serology (66.7%) whereas only 2/21 (9.5%) patients had detectable HCV RNA.
In conclusion, TDF is highly efficient in suppressing HIV and HBV replication in patients coinfected with HDV. However, in the majority of these patients TDF did not result in a reduction of HDV RNA or quantitative HBsAg. As replicating HDV infection is strongly associated with liver-related mortality, there is an urgent need for new treatment options.