Association of Hepatitis B Core-Related Antigen and Antihepatitis B Core Antibody With Liver Fibrosis Evolution in Human Immunodeficiency Virus-Hepatitis B Virus Coinfected Patients During Treatment With Tenofovir

Romuald Cruchet; Lorenza N C Dezanet; Sarah Maylin; Audrey Gabassi; Hayette Rougier; Patrick Miailhes; Caroline Lascoux-Combe; Julie Chas; Pierre-Marie Girard; Constance Delaugerre; Karine Lacombe; Anders Boyd

doi:10.1093/ofid/ofaa215

Association of Hepatitis B Core-Related Antigen and Antihepatitis B Core Antibody With Liver Fibrosis Evolution in Human Immunodeficiency Virus-Hepatitis B Virus Coinfected Patients During Treatment With Tenofovir

Open Forum Infect Dis. 2020 Jun 7;7(7):ofaa215. doi: 10.1093/ofid/ofaa215. eCollection 2020 Jul.

Authors

Romuald Cruchet^{1

2

3}, Lorenza N C Dezanet¹, Sarah Maylin⁴, Audrey Gabassi^{4

5}, Hayette Rougier⁶, Patrick Miailhes⁷, Caroline Lascoux-Combe⁸, Julie Chas⁹, Pierre-Marie Girard¹⁰, Constance Delaugerre^{4

5}, Karine Lacombe^{1

10}, Anders Boyd^{1

10}

Affiliations

¹ Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
² Hospices Civils de Lyon, Lyon, France.
³ Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, Lyon, France.
⁴ APHP, Hôpital Saint-Louis, Laboratoire de Virologie, Paris, France.
⁵ Université de Paris, INSERM U944, Institut de Recherche Saint-Louis, Paris, France.
⁶ IMEA, Institut de Médecine et d'Epidémiologie Appliquée, Paris, France.
⁷ Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Service des Maladies Infectieuses et Tropicales, Lyon, France.
⁸ APHP, Hôpital Saint-Louis, Service de Maladies Infectieuses, Paris, France.
⁹ APHP, Hôpital Tenon, Service de Maladies Infectieuses, Paris, France.
¹⁰ APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, Paris, France.

Abstract

Background: Quantitative hepatitis B core-related antigen (qHBcrAg) or antihepatitis B core antibody (qAnti-HBc) could be useful in monitoring liver fibrosis evolution during chronic hepatitis B virus (HBV) infection, yet it has not been assessed in human immunodeficiency virus (HIV)-HBV-coinfected patients undergoing treatment with tenofovir (TDF).

Methods: One hundred fifty-four HIV-HBV-infected patients initiating a TDF-containing antiretroviral regimen were prospectively followed. The qHBcrAg and qAnti-HBc and liver fibrosis assessment were collected every 6-12 months during TDF. Hazard ratios (HRs) assessing the association between qHBcrAg/qAnti-HBc and transitions from none/mild/significant fibrosis to advanced fibrosis/cirrhosis (progression) and from advanced fibrosis/cirrhosis to none/mild/significant fibrosis (regression) were estimated using a time-homogeneous Markov model.

Results: At baseline, advanced liver fibrosis/cirrhosis was observed in 40 (26%) patients. During a median follow-up of 48 months (interquartile range, 31-90), 38 transitions of progression (IR = 7/100 person-years) and 34 transitions of regression (IR = 6/100 person-years) were observed. Baseline levels of qHBcrAg and qAnti-HBc were not associated with liver fibrosis progression (adjusted-HR per log₁₀ U/mL = 1.07, 95% confidence interval [CI] = 0.93-1.24; adjusted-HR per log₁₀ Paul-Ehrlich-Institute [PEI] U/mL = 0.85, 95% CI = 0.70-1.04, respectively) or regression (adjusted-HR per log₁₀ U/mL = 1.17, 95% CI = 0.95-1.46; adjusted-HR per log₁₀ PEI U/mL = 0.97, 95% CI = 0.78-1.22, respectively) after adjusting for age, gender, duration of antiretroviral therapy, protease inhibitor-containing antiretroviral therapy, and CD4⁺/CD8⁺ ratio. Nevertheless, changes from the previous visit of qAnti-HBc levels were associated with liver fibrosis regression (adjusted-HR per log₁₀ PEIU/mL change = 5.46, 95% CI = 1.56-19.16).

Conclusions: Baseline qHBcrAg and qAnti-HBc levels are not associated with liver fibrosis evolution in TDF-treated HIV-HBV coinfected patients. The link between changes in qAnti-HBc levels during follow-up and liver fibrosis regression merits further study.

Keywords: antihepatitis B core antibody; cirrhosis; hepatitis B core-related antigen; human immunodeficiency virus; liver fibrosis.