Tenofovir Potent Anti-Hepatitis B Treatment for HIV-Coinfected Patients

The nucleotide analog tenofovir disoproxil fumarate exhibited potent activity against chronic hepatitis B virus (HBV) infection in patients coinfected with HIV in a prospective pilot study reported by physicians at the Washington University School of Medicine. Dr. Pablo Tebas and colleagues report on results in six such patients who had failed treatment with lamivudine and interferon-alpha. Their study, "Tenofovir Disoproxil Fumarate Therapy for Chronic Hepatitis B in Human Immunodeficiency Virus/Hepatitis B Virus Coinfected Individuals for Whom Interferon-Alpha and Lamivudine Therapy Have Failed," was published in the Journal of Infectious Diseases (2002;186(12):1844-1847).

Treatment with tenofovir 300 mg q.d. was added to their antiretroviral regimen, and five patients continued therapy with lamivudine or emtricitabine. By week 12, HBV RNA serum levels declined from a median of 7.95 log10 copies/mL to 4.8 log10 copies/mL. Further treatment until week 24 resulted in an additional decline to 3.6 log10 copies/mL. In two patients, HBV RNA was undetectable by study end. Furthermore, among three subjects in whom HIV RNA was above measurable levels at baseline, the HIV viral load decreased by .7 log10 copies/mL from a median of 3.1 log10 copies/mL.

Tebas and associates note that tenofovir was well tolerated, with only a mild increase of alanine aminotransferase by 17 U/L after 12 weeks of treatment from 53 U/L at baseline.

"The anti-HIV activity of tenofovir, which adefovir lacks, and its excellent tolerability in patients with advanced HIV infection, makes it more attractive for the patient with limited therapeutic options in which the goal of antiretroviral therapy is ... to try to lower as much as possible the HIV RNA load," the team wrote. The researchers suggest that combination treatment with lamivudine and tenofovir may augment antiviral activity and increase the "genetic barrier for the development of resistance."

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