Individuals who are coinfected with HIV and hepatitis B virus (HBV) and treated with 3TC, are more likely to clear HBV infection and have normal liver function if they have a CD4 cell count above 200 cells/mm3, according to a small Dutch study published in the July 4th edition of AIDS.
A case is also reported in the same edition of the journal involving a man infected with HIV and hepatitis C virus (HCV), and who had occult HBV infection, which became reactivated, causing fatal liver disease, when his CD4 cell count fell to a dnagerously low level.
In a retrospective study, the records of 29 HIV and HBV coinfected patients were analysed by investigators in Utrecht to establish the role of the immune system in the outcome of 3TC therapy. The drug was prescribed to 17 of the patients as part of their anti-HIV HAART regimen at the standard anti-HIV dose of 150mg twice daily.
Thirteen of the 17 patients (76%) had a CD4 cell count of above 200 cells/mm3, and 15 had chronic HBV replication (HBV DNA above 1000 copies/mL).
After six months of 3TC therapy, the 17 patients had a mean fall in HBV DNA of 1.3 log (p=0.018). However, when the patients were divided into two arms, a CD4 cell count greater than 200 cells/mm3 versus CD4 cell count below 200 cells/mm3, the investigators found that the median fall in HBV DNA was 1.9 log for those with CD4 cell counts of at least 200 cells/mm3 (p
Further, nine of the 13 patients with higher CD4 cell counts had achieved an undetectable HBV DNA after the six months of 3TC therapy compared to only two of the patients with a CD4 cell count below 200 cells/mm3. After 33 months of follow-up, nine of the 13 patients (69.2%) with a CD4 cell count of 200 cells/mm3 or above had normal liver function compared to two of the patients with greater immune damage.
The Dutch investigators conclude that their study highlights "the importance of the immune status of the host in the clearance of HBV and the restoration of liver function."
In a letter to the journal, Italian doctors report the case of a 37 year old man, coinfected with HIV and HCV, who also had occult HBV infection. The man was initially diagnosed with HCV, with blood tests revealing he was also HIV-positive. A liver biopsy indicated that he also had occult HBV infection. The man received interferon-alpha therapy for HCV, which was stopped after three months as the man was still HCV-positive with elevated liver enzymes. At this time the man's CD4 cell count was over 500 cells/mm3.
The man refused further HCV and HIV treatment, and was not seen in the clinic for six years, at which point he was hospitalised with acute liver failure. His CD4 cell count at this time was 40 cells/mm3, and he died a week after admission to hospital of fulmiant HBV with HIV and HCV coinfection. The doctors note, "in the case reported here the reactivation of occult HBV infection was strongly associated with CD4 cell depletion."
Further information on this website
Hepatitis B - overview
Hepatitis B - factsheet
BHIVA guidelines on the treatment of HIV/HBV coinfection
Occult HBV common in HIV/HCV coinfected patients - news story
3TC - overview
Haverkamp M et al. The effect of lamivudine on the replication of hepatitis B virus in HIV-infected patients depends on the host immune status (CD4 cell count). AIDS 17: 1572 - 74, 2003.
Fabris P et al. Occult hepatitis B virus infection in HIV/hepatitis C virus co-infected patients. AIDS 17: 1581 - 82, 2003.