3TC has pluses and minuses for patients with triple HIV/HBV/HCV infection

August 2, 2008

, Wednesday, July 30, 2008

The anti-hepatitis B effect of 3TC (lamivudine) in patients with HIV appears to

be greater in individuals who are also infected with hepatitis C, according to

Chinese research published in the August 1st edition of the Journal of Acquired

Immune Deficiency Syndromes. But the same study found that treatment with 3TC

also appeared to increase replication of hepatitis C in patients infected with

all three viruses.

Hepatitis B, hepatitis C and HIV can be transmitted in similar ways, and a large

number of HIV-positive patients are infected with either hepatitis B, hepatitis

C or both.

Since the advent of effective HIV treatment, liver disease caused by hepatitis B

and hepatitis C has emerged as a leading cause of death amongst patients with

HIV. But there is still little information on the impact of dual hepatitis B and

C virus coinfection on the prognosis of HIV-positive patients.

Chinese investigators therefore examined hepatitis B and C replication and the

risk of death in patients infected with HIV and hepatitis B and hepatitis C, and

compared this to patients who were only infected with HIV and hepatitis B.

Their study included 55 patients infected with all three viruses and 73

individuals with HIV and hepatitis B. The two groups of patients were broadly

similar, having average ages between 38 and 40 years.

Near equal proportions of patients in both groups were hepatitis B virus “e”

antigen-positive (18% triple infection vs. 19% HIV and hepatitis . This is an

indicator of chronic infection with hepatitis B.

Of the “e” antigen-negative patients, 25% of those with triple infection had

detectable hepatitis B RNA compared to 55% of patients with HIV and hepatitis B,

a statistically significant difference (p < 0.05).

After 15 months of antiretroviral treatment with a regimen that included 3TC, 6%

of patients with all three infections had detectable hepatitis B RNA compared

with 30% of patients infected with HIV and hepatitis B. Once again, this

difference was statistically significant (p < 0.05).

But the investigators also found that 3TC appeared to increase replication of

hepatitis C. Of the triple-infected patients who were treated with this drug,

80% had detectable hepatitis C compared with 43% of triple-infected patients who

received antiretroviral treatment without 3TC (p < 0.005).

Rates of end-stage liver disease were lower amongst patients with triple

infection (0. 40 per 100 person years) compared to those with HIV and hepatitis

B infection (0.53 per 100 person years, p < 0.05). Furthermore mortality caused

by liver disease was also lower amongst the patients with all three infections

compared to those with just HIV and hepatitis B (1.22 per 100 person years vs.

2.44 per 100 person years, p < 0.05).

Noting the different impact of 3TC therapy for patients with triple infection

compared to HIV and hepatitis B infection, the investigators write that “further

study is needed on the best antiretroviral regimens for patients with

[HIV/hepatitis B/hepatitis C] triple infection.

Reference

Rong-rong Y. et al. Interaction of hepatitis B and C viruses in patients

infected with HIV. J Acquir Immune Defic Syndr 48: 491 – 92, 2008.

August 2, 2008