Abstract
Background: Hepatitis B virus (HBV) coinfection is common in HIV-positive patients. HIV infection modifies the natural course of HBV infection, leading to a faster progression of liver-related morbidity and mortality than is observed in HBV mono-infected patients. This systematic review and meta-analysis evaluates the current clinical evidence regarding the use of oral tenofovir disproxil fumarate (TDF)-based treatments in patients coinfected with HIV and HBV.Methods: We performed a comprehensive literature search in PubMed and Web of Science. Supplementary searches were conducted in Google Scholar and Clinicaltrials.gov. We conducted a random effects meta-analysis using the event rate (ER) to estimate the incidence of HBV seroconversion. A subgroup meta-analysis was performed to assess the moderate effects of demographic and disease-related variables on HBsAg loss. This review is registered in the PROSPERO database (CRD42018092379).Results: We included 11 studies in the review. The immunological effects of oral TDF-based Pre-exposure prophylaxis (PrEP) treatment in patients with HIV-HBV coinfection were 0.249 for HBeAg loss, 0.237 for HBeAg conversion, 0.073 for HBsAg loss, and 0.055 for HBsAg conversion. The factors associated with HBsAg loss were the baseline HBV viral load, participant’s location, and a history of exposure to lamivudine/emtricitabine (3TC/FTC) (all p < 0.05). A trend toward a negative relationship between the baseline CD4+ T-cell count and HBsAg loss was observed (p = 0.078).Conclusion: This systematic review and meta-analysis demonstrated that TDF-containing regimens are effective at stimulating HBeAg loss (24.9%), HBeAg conversion (23.7%), HBsAg loss (7.3%), and HBsAg conversion (5.5%) in HIV-HBV coinfected patients. The moderator analysis showed that HBV viral load, the location of participants, and prior exposure to 3TC/FTC are factors associated with HBsAg loss. Asian ethnicity, prior exposure to 3TC, and a nondetectable baseline HBV viral load are associated with lower odds of HBsAg loss. Well-designed prospective cohort studies and randomized controlled trials (RCTs) with large sample sizes are required for the investigation of potential predictors and biological markers associated with strategies for achieving HBV remission in patients with HIV-HBV coinfection, which is a matter of considerable importance to clinicians and those responsible for health policies.
Highlights
5–25% of acquired immunodeficiency syndrome (AIDS) patients are coinfected with hepatitis B virus (HBV) (Unaids, 2018)
This systematic review and meta-analysis were performed in accordance with PRISMA guidelines (Moher et al, 2009a; Moher et al, 2009b; Moher et al, 2009c), and the study is registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/ PROSPERO/): CRD42018092379
To be more specific, 1) the participants were Human immunodeficiency virus (HIV)-HBV coinfected patients at the screening stage of each study; 2) the eligible intervention contained Tenofovir disproxil fumarate (TDF) with or without 3TC and/or FTC, which are commonly used treatment combinations in most countries and regions; 3) some studies included in our meta-analysis were single-arm observational cohorts, while some studies compared the effectiveness between different treatment regimens; if the study arms used the medication combinations of interest, we included all arms; 4) because we aimed to investigate the immunological effects of targeted treatments, the outcomes of interest were HBV-related physiological processes during treatment
Summary
5–25% of acquired immunodeficiency syndrome (AIDS) patients are coinfected with hepatitis B virus (HBV) (Unaids, 2018). Human immunodeficiency virus (HIV) infection modifies the natural course of HBV infection, leading to a faster progression of liver-related morbidity and mortality than is observed in HBV mono-infected individuals, accompanied by a higher prevalence of antiretroviral therapy (ART)-related hepatotoxicity (Avihingsanon et al, 2010). A recent study showed that TDF treatment resulted in undetectable levels of HBV in approximately 90% of patients with HIV-HBV coinfection. This proportion increased rapidly over the first 2 years of treatment and continued to rise slowly thereafter (Price et al, 2013). This systematic review and meta-analysis evaluates the current clinical evidence regarding the use of oral tenofovir disproxil fumarate (TDF)-based treatments in patients coinfected with HIV and HBV
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