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Abreu RM, Bassit LC, Tao S, Jiang Y, Ferreira AS, Hori PC, Ganova-Raeva LM, Khudyakov Y, Schinazi RF, Carrilho FJ, Ono SK. Long-term virological and adherence outcomes to antiviral treatment in a 4-year cohort chronic HBV study. Antivir Ther 2020; 24:567-579. [PMID: 31799942 DOI: 10.3851/imp3338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 02/08/2023]
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.
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Affiliation(s)
- Rodrigo M Abreu
- Divisão de Gastroenterologia e Hepatologia Clínica do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia da Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.,Divisão de Farmácia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Leda C Bassit
- Laboratory of Biochemical Pharmacology, Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sijia Tao
- Laboratory of Biochemical Pharmacology, Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Yong Jiang
- Laboratory of Biochemical Pharmacology, Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Aline S Ferreira
- Divisão de Gastroenterologia e Hepatologia Clínica do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia da Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Patrícia Ca Hori
- Divisão de Farmácia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Lilia M Ganova-Raeva
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yury Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raymond F Schinazi
- Laboratory of Biochemical Pharmacology, Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Flair J Carrilho
- Divisão de Gastroenterologia e Hepatologia Clínica do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia da Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Suzane K Ono
- Divisão de Gastroenterologia e Hepatologia Clínica do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia da Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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