Patiënten met een coïnfectie van HIV en hepatitis-B-virus (HBV): Gunstig effect van lamivudine, als onderdeel van antiretrovirale combinatiebehandeling, op HBV mogelijk afhankelijk van het CD4-celaantal

Objective. To determine the effect of lamivudine on HBV co-infection in HIV-infected patients. Design. Retrospective Method. The HBsAg status and the use of lamivudine were determined retrospectively in a cohort of 800 HIV-infected patients under treatment at the Infectious Diseases outpatient clinic of the University Medical Centre in Utrecht, the Netherlands. In the group of HBsAg-positive patients using lamivudine 150 mg twice daily as part of highly active antiretroviral therapy (HAART), the HBV-DNA was measured quantitatively in the remaining plasma. In addition, the HBsAg, HBeAg, activity of alanineaminotransferase (ALAT) and CD4-count were obtained from the patient records. Results. The study identified 29 (3.6%) HIV-infected patients to be HBsAg-positive. Plasma samples of 14 of these 29 patients were positive for HBV-DNA before the start of the therapy. Ten of these 14 patients had CD4 counts of at least 200 × 10⁶ cells/l, while four patients had less than 200 × 10⁶ cells/l. In contrast to the group with less than 200 × 10⁶ cells/l, a significant decrease in HBV-DNA load was seen after six months of therapy in the patients with at least 200 × 10⁶ CD4-cells/l (t-test for repeated measurements; p = 0.001). The difference between the two groups in the effect of lamivudine was statistically significant (p = 0.021). At final evaluation after a mean follow-up of 32 and 13 months, respectively, HBV-DNA could no longer be detected in 7 patients; ALAT normalised in 9 patients (64%). Conclusion. In this retrospective study, lamivudine was effective in the therapy of HIV-infected patients with a HBV co-infection. The decrease in the amount of circulating HBV was associated with the number of CD4 cells.