| International Session（Panel Discussion）1(JSH・JSGE・JSGCS) |
| Fri. November 6th 9:40 - 12:00 Room 8: Portopia Hotel Main Building Kairaku 1+2 |
| Impact of Immune Reconstitution-induced Hepatic Flare on HBsAg Loss in HBV/HIV-1-Coinfected Patients | |||
| Sachiyo Yoshio1, Shiori Yoshikawa1, Tatsuya Kanto1 | |||
| 1Department of Liver Disease, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine | |||
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| Aims: In patients with HIV/HBV co-infection, it is strongly required to achieve HBsAg loss to improve prognosis. Antiretroviral therapy (ART) of HBV/HIV-1-coinfected patients can lead to hepatic flare (HF) caused by immune reconstitution-induced inflammatory syndrome (IRIS). Here, we investigated the impact of IRIS-induced hepatic flare (IRIS-HF) on the clinical course of chronic hepatitis B infection. Methods: This was a retrospective study of 55 HBV/HIV-1-coinfected subjects who had been HBsAg-positive for ≥6 months before ART initiation and were followed for ≥3 years (mean 9.2 years) after ART initiation. Results: Of the 55 patients, 14 (25.5%) developed IRIS-HF within 12 months of ART initiation. In all cases, IRIS-HF was not accompanied by elevation of serum HBV DNA, and resolved without cessation of ART. After 3 years of ART, HBsAg loss was observed in 13 of 55 patients (23.6%). HBsAg loss was significantly more frequent among patients who developed IRIS-HF (8/14, 57.1%) than those who did not (5/41, 12.2%).Younger age and a greater increase in CD4 T cell count in the first month of ART were independent predictors of IRIS-HF. In turn, IRIS-HF was an independent predictor of subsequent HBsAg loss. Conclusions: IRIS-HF was predictive of HBsAg loss, supporting the notion that immune reconstitution accompanying beneficial ALT flare is a key for attaining functional cure. |
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Index Term 1: functional cure Index Term 2: hepatic flare |
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