Impact of lamivudine on the risk of liver-related death in 2,041 HBsAg- and HIV-positive individuals : results from an inter-cohort analysis

• Published in: Antiviral therapy Vol. 11; no. 5; pp. 567 - 574
• Main Authors: PUOTI, Massimo, COZZI-LEPRI, Alessandro, WINNOCK, Maria, MILAZZO, Laura, GERVAIS, Anne, RAFFI, Francois, GILL, John, ROCKSTROH, Juergen, QURISHI, Nazifa, MUSSINI, Cristina, CASTAGNA, Antonella, DE LUCA, Andrea, ARICI, Claudio, MONFORTE, Antonella Darminio, MOLLER, Nina Friis, LUNDGREN, Jens D, LEDERGERBER, Bruno, RICKENBACH, Martin, SUAREZ-LOZANO, Ignacio, GARRIDO, Myriam, DABIS, Francois
• Format: Journal Article
• Language: English
• Published: London International Medical Press 01.01.2006
• Subjects: Adult; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Biological and medical sciences; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - immunology; Carcinoma, Hepatocellular - mortality; CD4 Lymphocyte Count; Drug Therapy, Combination; Female; Hepatitis B - drug therapy; Hepatitis B - immunology; Hepatitis B - mortality; Hepatitis B Surface Antigens - blood; Hepatitis C Antibodies - blood; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - mortality; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Lamivudine - therapeutic use; Liver Neoplasms - drug therapy; Liver Neoplasms - immunology; Liver Neoplasms - mortality; Male; Medical sciences; Pharmacology. Drug treatments; Retrospective Studies; Reverse Transcriptase Inhibitors - therapeutic use; Risk Factors; Survival Analysis; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Antiretroviral agent; RNA-directed DNA polymerase; Liver; Orthohepadnavirus; Hepadnaviridae; Reverse transcriptase inhibitor; Nucleoside analog; Antiviral; Hepatitis B virus; Pyrimidine nucleoside; Public health; Human; Immunopathology; Hepatitis B surface antigen; Enzyme; Transferases; Mortality; Enzyme inhibitor; Lamivudine; AIDS; Immune deficiency; Infection; Virus; Nucleotidyltransferases; Dideoxynucleoside; Viral disease; Risk factor; Death
• ISSN: 1359-6535; 2040-2058
• DOI: 10.1177/135965350601100509

The impact of lamivudine (3TC) as part of combination antiretroviral therapy (cART) on the risk of liver-related death (LRD) in HIV/hepatitis B virus (HBV)-coinfected patients has not been extensively studied. We performed an analysis involving HIV/HBV-coinfected patients in 13 cohorts who initiated cART. The end-point was LRD--that is, death with concomitant decompensated liver disease (DLD) or hepatocellular carcinoma--as the main cause. Incidence rates of LRD after initiation of cART were expressed as number of events per 100 person-years of follow-up (PYFU). A Poisson regression model adjusted for cohort, gender, mode of HIV transmission, CD4+ T-cell count at cART initiation, liver disease pre-cART, duration of 3TC before cART, and hepatitis C virus was used to assess the association between use of 3TC and risk of LRD. We analysed 2,041 patients. Follow-up after starting cART was 7,648 PYFU (5,569 spent on 3TC-containing regimens) with a median per person of 48 months (range: 2-91). Of the total, 217 subjects died; 57 deaths were liver-related resulting in a rate of 7.5 per 1,000 PYFU [95% confidence intervals (CI): 5.6-9.7]. The relative risk of LRD per extra year of 3TC use was 0.73 (95% CI: 0.59-0.90, P = 0.004). The use of 3TC was associated with a reduced risk of LRD over 4 years of follow-up. This study supports the current view that the use of 3TC as part of cART should be considered in patients who are tested positive for HBsAg.