Anchalee Avihingsanon, MD, PhD, HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, is principal investigator of the ALLIANCE trial from Gilead.
The ALLIANCE trial from Gilead is investigating the triplet regimen of bictegravir/emtricitabine/tenofovir alafenamide (TAF) vs dolutegravir plus emtricitabine/tenofovir disoproxil fumarate (TDF) among treatment-naïve persons living with comorbid HIV/hepatitis B virus (HBV). Anchalee Avihingsanon, MD, PhD, HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, is the trial’s principal investigator.
Can you discuss how the ALLIANCE trial addresses HIV/HBV coinfection overlapping risk factors and transmission patterns?
The literature shows a risk factor mainly from men having sex with men and intravenous drug users. In hep B, the main transmission is from the breath; [transmission] from sexual activity is very rare, but we have seen much higher [rates] among men having sex with men. For HIV and hepatitis B, they usually have a high hepatitis B, D, and A viral load. If you have such a high viral load, you can transmit the virus to others really easily like with HIV. I think we should use the term “treatment as prevention” as well. Hepatitis B has a vaccine to prevent infection, but in some groups, the vaccine doesn’t work or it doesn’t work quite well.
For this study, we know that the HIV suppression is very high for both TDF and TAF—and this is good for HIV. Even they have such high rates of HIV suppression, when you look at the hepatitis B, it’s only 60% for TAF and 40% for TDF. So there are some subpopulations that have [suboptimal] hepatitis B treatment, but we need longer follow-up to see whether the suppression will be higher on this or not.
For me, I think if we treat the patient so we can prevent transmission of this virus to others, if we use the most effective drug, then you can lower the viruses quicker.