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Logo of aidsrestherBioMed CentralBiomed Central Web Sitesearchsubmit a manuscriptregisterthis articleAIDS Research and Therapy
 
AIDS Res Ther. 2012; 9: 6.
Published online 2012 March 9. doi:  10.1186/1742-6405-9-6
PMCID: PMC3324378

Assessment of HBV flare in a randomized clinical trial in HIV/HBV coinfected subjects initiating HBV-active antiretroviral therapy in Thailand

Abstract

Abstract

Background

Hepatic Flare (HF) after initiation of highly active antiretroviral therapy (HAART) in HIV-HBV coinfected individuals is well recognized but prospective data on predictors and subsequent outcome are limited.

Methods

The Tenofovir in HIV-HBV coinfection study was a randomized clinical trial of HBV-active HAART including lamivudine and/or tenofovir in antiretroviral naïve HIV-HBV individuals in Thailand.

Results

Early HF (EHF) was defined as ALT > 5 × ULN during the first 12 weeks. EHF was observed in 8 (22%) of individuals at a median of 56 days. 6/8 EHF cases were asymptomatic and resolved with HAART continuation, however one subject with underlying cirrhosis died following rapid hepatic decompensation. EHF was significantly associated with higher baseline ALT (79 IU/L vs 36 IU/L non-EHF, p = 0.008) and HBV DNA (9.9 log10 c/ml vs 8.4 log10 c/ml non EHF, p = 0.009), and subsequent serological change. HBeAg loss occurred in 75% of EHF cases versus 22% in non-EHF (p = 0.04), and HBsAg loss in 25% of EHF cases versus 4% of non-EHF (p = 0.053).

Conclusion

EHF after HBV active HAART initiation was frequently observed in this population. Timing of EHF, association with elevated ALT and HBV DNA and high rate of seroconversion are all consistent with immune restoration as the likely underlying process.

Clinical Trial number

NCT00192595.

Keywords: Hepatitis B, HIV, Antiretroviral therapy, Asia, Hepatic flare, Hepatotoxicity

Articles from AIDS Research and Therapy are provided here courtesy of BioMed Central