Long-term virological and adherence outcomes to antiviral treatment in a 4-year cohort chronic HBV study

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Abreu, Rodrigo M. ; Bassit, Leda C. ; Tao, Sijia ; Jiang, Yong ; Ferreira, Aline S. ; Hori, Patricia Ca ; Ganova-Raeva, Lilia M. ; Khudyakov, Yury ; Schinazi, Raymond F. ; Carrilho, Flair J. ; Ono, Suzane K.

• Document type: Journal article
• Source: ANTIVIRAL THERAPY; v. 24, n. 8, p. 13-pg., 2019-01-01.

Abstract

Background: Chronic hepatitis B (CHB) treatment adherence has been poorly studied worldwide. We evaluated long-term virological and adherence outcomes to antiviral treatment in CHB patients. Methods: A prospective 183 Brazilian CHB patient cohort treated with monotherapy or combination adefovir dipivoxil, entecavir, lamivudine and/or tenofovir disoproxil fumarate was studied in a reference tertiary centre. Treatment adherence was evaluated by a validated questionnaire named 'Assessment of Adherence to Antiviral Therapy Questionnaire' (CEAT-HBV) within three yearly periods (2010/2011, 2013/2014 and 2014/2015). Results: CEAT-HBV identified 43% (79/183) patients with non-adherence to antiviral treatment and among them, 67% (53/79) were viral load positive. The main causes associated with non-response to antiviral treatment were drug resistance variants followed by non-adherence, insufficient treatment duration and other causes. Single-dose pharmacokinetics demonstrated 35% (23/65) antiviral non-adherence. 2 years after the first assessment, the CEAT-HBV indicated that 71% (101/143) of subjects adhered to treatment (per-protocol population). However, 21% (40/183) of the patients could not be evaluated and were excluded. The main reasons for exclusion were death (20/183), 11 out 20 deaths due to hepatocellular carcinoma. HBV booklet was used for medical education. The third CEAT-HBV assessment (2014/2015) showed that 83% (112/135) patients were compliant with treatment adherence (per-protocol population). Long-term evaluation showed that adherence rate based on CEAT-HBV continue to increase after 4-years (P<0.001). Conclusions: The results highlight the importance of CHB therapy adherence assessment monitoring. Long-term adherence outcomes were dynamic and it is possible to increase the migration rate to adherence/HBV-DNA-negative group. (AU)

• FAPESP's process: 17/50042-2 - Discussion of research projects involving chronic Hepatitis B and C antiviral treatment
• Grantee: Suzane Kioko Ono
• Support Opportunities: Regular Research Grants