HIV and hepatitis B virus (HBV) outcomes after switching stavudine or zidovudine to tenofovir in subjects receiving first-line antiretroviral therapy (ART) in Ghana

HBV co-infection rates exceed 16% among HIV-positive adults in Ghana. ART has traditionally been "HBV-blind" and comprised zidovudine or stavudine with lamivudine plus nevirapine or efavirenz, without virological monitoring. In 2011 HBsAg screening was introduced in the Kumasi HIV cohort and HbsAg positive subjects gradually replaced zidovudine or stavudine with tenofovir (TDF). The study aim was to investigate outcomes of TDF introduction. HEPIK is a prospective observational study characterizing the virological and clinical expression of HBV co-infection in the Kumasi HIV cohort; 82 HIV/ HBV co-infected subjects have completed median 6.1 months of follow-up after TDF introduction. Introducing TDF improved control of HBV replication in heavily lamivudine-experienced patients. Among subjects with HBV resistance HBV DNA levels declined by 4.4 log10 IU/ml after 6 months. There remains scope for improved control of HIV replication.