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

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 1^st 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 B). 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

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

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

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

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.