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Addition of PEG-IFN to ART does not improve hepatitis B clearance rates

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September 15, 2016

The addition of pegylated interferon to tenofovir-containing ART did not improve long-term hepatitis B e and surface antigen clearance rates in patients coinfected with hepatitis B and HIV, according to recent findings.

“Although faster declines in [quantified hepatitis B e antigen (qHBeAg)] and, to a lesser extent, [quantified hepatitis B surface antigen (qHBsAg)] were observed during intensification [of pegylated interferon (PEG-IFN)], there was no advantage in qHBeAg or qHBsAg decline thereafter and no difference in HBeAg seroclearance or HBsAg seroclearance rates in patients with PEG-IFN intensification compared to [tenofovir disoproxil fumarate (TDF)] alone,” Anders Boyd, PhD, MPH, at Hôpital Saint-Atoine in France, and colleagues wrote. “More importantly, PEG-IFN intensification was associated with a significantly higher rate of grade 3/4 laboratory abnormalities.”

To assess the long-term effect of PEG-IFN intensification during ART, Boyd and colleagues studied 46 patients who received PEG-IFN for 1 year during TDF therapy (median TDF exposure at baseline, 39.8 months). The median quantified hepatitis B antigen levels at baseline were 6.9 PEIU/mL for e antigen and 3.72 log10 IU/mL for surface antigen. These patients were matched in a 1:1 ratio with controls who did not take PEG-IFN, using a time-dependent propensity score based on age, CD4+ count and liver cirrhosis status. Afterward, the researchers estimated the rates of qHBeAg and qHBsAg at a median follow-up of 33.4 months.

During intensification, the researchers observed faster average monthly declines in the PEG-IFN group for both qHBeAg (–0.066 vs. –0.027 PEIU/mL; P = .001) and qHBsAg (–0.049 vs. –0.026 log10 IU/mL). After intensification, however, there was no difference between groups. Overall, the researchers observed no differences between groups in the clearance rates for both HBeAg (13.2 vs 12.6/100 person-years) and HBsAg (1.8 vs. 1.3/100 person-years). In addition, grade 3/4 serious adverse events were more frequent in the intensification group (32.6% vs. 2.2%; P < .001).

“Due to its high cost, lower tolerance and low efficacy, PEG-IFN intensification is not recommended for this specific patient group,” the researchers wrote. “Still, our findings underscore the need for other therapeutic agents to increase seroclearance and seroconversion rates in coinfected individuals.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.

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