Uptake of tenofovir-based antiretroviral therapy among HIV/HBV co-infected patients in the EuroSIDA study. Antiviral Therapy
Peters et al. on behalf of the EuroSIDA study aimed to study regional differences in uptake of tenofovir disoproxil fumarate (TDF-) based combination antiretroviral therapy (cART) and factors associated with its use among HIV/hepatitis B virus (HBV) co-infected patients across Europe.
Overall, 953 HBsAg+ patients were followed up after 1 March 2002. Median age was 41 years and patients were predominantly male (85%), white (82%) and ART experienced (88%). 697 and 256 were from Western and Eastern Europe, respectively. Fifty-five started cART during follow-up, the proportion starting with CD4
- TDF use, among those taking cART, increased from 4% in 2002 to 73% in 2015.
- Compared to West, TDF use was lower in East in 2005 (7% vs. 42%), and remained lower in 2015 (63% vs. 76%).
- Among 602 patients taking TDF-based cART during follow-up. 155 (26%) discontinued TDF.
- Twenty-seven (17%) of all TDF discontinuations were due to adverse events.
- Only 14 started entecavir and/or adefovir after TDF discontinuation, whereas ten started PEG-IFN.
- TDF use was not significantly associated with lower risk of liver-related clinical events (N=51), adjusted IRR 0.64 (95% CI 0.35-1.18) for comparing patients on TDF with those off TDF.
In conclusion, in this large pan-European observational study we have shown a large proportion of HIV/HBV co-infected patients have started cART late and seem to receive sub-optimal coverage against HBV, in particular in Eastern Europe. Discontinuations of TDF without replacement with antiviral agents with sufficient antiviral coverage against HBV are common, and put the patients at risk of hepatic flares and progression of liver disease. Longer follow-up is warranted to investigate whether treatment with less potent HBV active antivirals translates into greater risk of clinical liver disease and death among HIV/HBV co-infected patients.