Tenofovir and Delta hepatitis

2017-06-30

In the Swiss Human Immunodeficiency Virus Cohort all patients with HIV and hepatitis B coinfection were tested for delta hepatitis. Patients with HDV-RNA > 300 copies/mL at initiation of tenofovir (TDF) therapy and who had a follow up sample after at least one year were included in an observational study of the effect of tenofovir on hepatitis delta virus replication. Of 73 patients with replicating HDV 21 fulfilled the inclusion criteria. Most participants had already been on antiretroviral therapy before initiating a tenofovir containing regimen. Patients were followed for a median of 4.9 years. Median HDV-RNA was 7.0 log10 before treatment start and 6.7 log 10 in the last follow up sample. 16/21 patients reached HBV-DNA suppression after a median of 2.9 years. Six patients had a reduction of HDV-RNA greater than 2 log10. 3 patients achieved undetectable HDV-RNA. The authors conclude that tenofovir is not effective in a majority of patients and that there is an urgent need for new treatment options.

Béguelin et al. Clin Infect Dis 2017;64:1275-1278

Comment: There are only very limited studies of the long term effect of tenofovir on delta hepatitis and they have shown conflicting
results with a Spanish study showing significant reduction of HDV-RNA while a French study did not show any effect on HDV-RNA. In the present study only a minority had a significant
reduction of HDV-RNA and only 3 of 21 achieved non detectable HDV-RNA The overall effect of tenofovir on delta hepatitis seems very limited.