Περίληψη:
Background: According to guidelines all HIV-HBV-coinfected patients
should receive tenofovir-based combination antiretroviral therapy
(cART). We aimed to investigate uptake and outcomes of tenofovir-based
cART among HIV-HBV patients in the EuroSIDA study.
Methods: All hepatitis B surface antigen (HBsAg)+ patients followed up
after 1 March 2002 were included. Changes in the proportion taking
tenofovir-based cART over time were described. Poisson regression was
used to investigate the relationship between tenofovir use and clinical
events.
Results: 953 HIV-HBV patients were included. 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. 55 started cART during follow-up, the proportion
starting with CD4(+) T-cell count <350 cells/mm(3) decreased from 85%
to 52% in the periods 2002-2006 to 2007-2015. Tenofovir use, among
those taking cART, increased from 4% in 2002 to 73% in 2015. Compared
to West, tenofovir use was lower in East in 2005 (7% versus 42%), and
remained lower in 2015 (63% versus 76%). Among 602 patients taking
tenofovir-based cART during follow-up, 155 (26%) discontinued
tenofovir. 27 of all discontinuations were due to adverse effects. Only
14 started entecavir and/or adefovir after tenofovir discontinuation,
whereas 10 started pegylated interferon. Tenofovir use was not
significantly associated with lower risk of liver-related clinical
events (n=51), adjusted incidence rate ratio (IRR) 0.64 (95% CI 0.35,
1.18) for comparing patients on tenofovir with those off tenofovir.
Conclusions: Although use of tenofovir-based cART among HIV-HBV patients
has increased across Europe, a substantial proportion are still starting
cART late and are receiving suboptimal HBV therapy.
Συγγραφείς:
Peters, Lars
Mocroft, Amanda
Grint, Daniel
Moreno, Santiago
and Calmy, Alexandra
Jevtovic, Djordje
Sambatakou, Helen and
Lacombe, Karine
De Wit, Stephane
Rockstroh, Juergen
Smidt,
Jelena
Karpov, Igor
Grzeszczuk, Anna
Haziosmanovic,
Vesnadarjan
Gottfredsson, Magnus
Radoi, Roxana
Kuzovatova,
Elena
Orkin, Chloe
Ridolfo, Anna Lisa
Zapirain, Jose and
Lundgren, Jens
