Abstract

BackgroundThere are randomized trials assessing a variety of antiviral drugs for hepatitis B virus (HBV), but the relative effectiveness of these drugs in the treatment of patients co-infected with human immunodeficiency virus (HIV) remains unclear. The objectives of the current study were to estimate and rank the relative effectiveness of antiviral drugs for treating HBV and HIV co-infected patients.MethodsRandomized trials, assessing the efficacy of antiviral drugs for HBV and HIV co-infected patients were searched in health-related databases. The methodological quality of the included trials was evaluated using the Cochrane risk of bias tool. Main outcome in this meta-analysis study was the success of treatment by antivirals as determined by virologic response. We performed pairwise and network meta-analysis of these trials and assessed the quality of evidence using the GRADE approach.ResultsSeven randomized trials (329 participants) were included in this network meta-analysis study. A network geometry was formed with six treatment options including four antiviral drugs, adefovir (ADV), emtricitabine (FTC), lamivudine (LMV) and tenofovir disoproxil fumarate (TDF), combination treatment of TDF plus LMV, and placebo. The weighted percentage contributions of each comparison distributed fairly equally in the entire network of evidence. An assumption of consistency required for network meta-analysis was not violated (the global Wald test for inconsistency: Chi2(4) = 3.63, p = 0.46). The results of estimates showed no differences between the treatment regimens in terms of viral response for treating HBV and HIV co-infected patients, which spanned both benefit and harm (e.g. LMV vs TDF plus LMV: OR: 0.37, 95%CI: 0.06–2.41). Overall, the certainty of evidence was very low in all comparisons (e.g. LMV vs TDF plus LMV: 218 fewer per 1000,121 more to 602 fewer, very low certainty). Therefore, we remained uncertain to the true ranking of the antiviral treatments in HBV/ HIV co-infected patients.ConclusionsThe findings suggest that the evidence is insufficient to provide guidance to the relative effectiveness of currently available antiviral drugs with dual activity in treating co-infection of HBV/HIV. Well-designed, large clinical trials in this field to address other important outcomes from different epidemiological settings are recommended.

Highlights

  • There are randomized trials assessing a variety of antiviral drugs for hepatitis B virus (HBV), but the relative effectiveness of these drugs in the treatment of patients co-infected with human immunodeficiency virus (HIV) remains unclear

  • Among the 40 million persons infected with HIV worldwide, an estimated 2–4 million are co-infected with HBV [4], albeit with variation in age-specific prevalence, geographic distribution and the predominant routes of transmission [4, 5]

  • It has been reported that HIV infection has negative impact on the natural history of HBV infection leading to increased rates of persistent infection, higher HBV DNA levels, lower rates of hepatitis Be antigen loss, increased cirrhosis and liver-related mortality, and increased risk of hepatocellular carcinoma (HCC) at lower CD4+ T cell counts [6]

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Summary

Introduction

There are randomized trials assessing a variety of antiviral drugs for hepatitis B virus (HBV), but the relative effectiveness of these drugs in the treatment of patients co-infected with human immunodeficiency virus (HIV) remains unclear. The objectives of the current study were to estimate and rank the relative effectiveness of antiviral drugs for treating HBV and HIV co-infected patients. Human immunodeficiency virus (HIV) is an RNA virus and hepatitis B virus (HBV) is a partially double stranded DNA virus, both of which share common modes of transmission. Studies have reported that co-infection with HBV and HIV-1 is common [1,2,3]. The treatment of chronic HBV in HIV-infected individuals with dual antiretroviral therapy (ART) requires careful consideration. In co-infected patients, HIV accelerates the progression of HBV-related liver disease. The aim of treating HBV infection is to prevent patients from progressing to the chronic stage [7, 8]

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