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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Impact of lamivudine on HIV and hepatitis B virus-related outcomes in HIV/hepatitis B virus individuals in a randomized clinical trial of antiretroviral therapy in southern Africa
AIDS, Volume 25, No. 14, Year 2011
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Description
Objective: To examine HIV and hepatitis B virus (HBV)-related outcomes in HIV/HBV-coinfected participants in the PHIDISA II study by use of HBV-active vs. non-HBV-active antiretroviral therapy (ART). Design and Methods: PHIDISA II was a randomized study of ART therapy in HIV-infected adults employing zidovudine along with didanosine, or lamivudine along with stavudine in a factorial 2x2 design. HIV/HBV-coinfected participants by randomization received HBV-active or non-HBV-active ART. The following outcomes of interest were examined: immunological recovery and HIV RNA suppression; hepatic flare; HBV DNA suppression; and mortality. Results: HIV/HBV coinfection was present in 106 of 1771 (6%) of participants. Participants with HIV/HBV coinfection were more likely to be men, and have higher baseline alanine aminotransferase, lower albumin, and lower platelets than those with HIV monoinfection. Median CD4 + cell gain and HIV RNA suppression was similar across all groups. Hepatic flare was observed in 9.4% of coinfected and 0.02% monoinfected participants. HBV DNA suppression (<55IU/ml) at week 48 was observed in only 33% of those on lamivudine vs. 13% in those on no HBV-active drugs (P=0.13). Mortality over follow-up was significantly greater in coinfected (17%) than monoinfected (11%) participants (P=0.04). Conclusion: In summary, the use of lamivudine-containing ART in HIV/HBV participants in PHIDISA II resulted in little additional benefit over that of ART itself and failed to impact on the greater mortality in this group. These data provide strong support for recent guidelines advocating the use of tenofovir in all HIV-HBV-coinfected individuals initiating ART. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Matthews, Gail V.
Australia, Kensington
The Kirby Institute
Manzini, Prince
South Africa, Centurion
South African National Defence Force
Hu, Zonghui
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Khabo, Paul
South Africa, Centurion
South African National Defence Force
Maja, Patrick
South Africa, Centurion
South African National Defence Force
Matchaba, Gugu
South Africa, Centurion
South African National Defence Force
Sangweni, Phumele
South Africa, Centurion
South African National Defence Force
Metcalf, Julia A.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Pool, Nicholaas
South Africa, Johannesburg
Bio Analytical Research Corporation
Orsega, Susan M.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Emery, Sean
Australia, Kensington
The Kirby Institute
Statistics
Citations: 52
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1097/QAD.0b013e328349bbf3
e-ISSN:
14735571
Research Areas
Genetics And Genomics
Infectious Diseases
Study Design
Randomised Control Trial
Cohort Study
Participants Gender
Male