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Background: Hepatitis B coinfection is common in HIV-positive individuals and as antiretroviral therapy has made death due to AIDS less common, hepatitis has become increasingly important. Several drugs are available to treat hepatitis B. The most potent and the one with the lowest risk of resistance appears to be tenofovir (TDF). However there are several questions that remain unanswered regarding the use of TDF, including the proportion of patients that achieves suppression of HBV viral load and over what time, whether suppression is durable and whether prior treatment with other HBV-active drugs such as lamivudine, compromises the efficacy of TDF due to possible selection of resistant HBV strains.
Methods: A systematic review and meta-analysis following PRISMA guidelines and using multilevel mixed effects logistic regression, stratified by prior and/or concomitant use of lamivudine and/or emtricitabine.
Results: Data was available from 23 studies including 550 HBV/HIV coinfected patients treated with TDF. Follow up was for up to seven years but to ensure sufficient power the data analyses were limited to three years. The overall proportion achieving suppression of HBV replication was 57.4%, 79.0% and 85.6% at one, two and three years, respectively. No effect of prior or concomitant 3TC/FTC was shown. Virological rebound on TDF treatment was rare.
Interpretation: TDF suppresses HBV to undetectable levels in the majority of HBV/HIV coinfected patients with the proportion fully suppressed continuing to increase during continuous treatment. Prior treatment with 3TC/FTC does not compromise efficacy of TDF treatment. The use of combination treatment with 3TC/FTC offers no significant benefit over TDF alone.
Ten morphologically similar species of Acrapex Hampson, 1891 (Lepidoptera, Noctuidae, Noctuinae, Apameini) from Central and Eastern Africa are reviewed, including five new species: Acrapex kafula le Ru sp. nov., A. kavumba le Ru sp. nov., A. kiakouama le Ru sp. nov., A. miscantha le Ru sp. nov. and A. simillima le Ru sp. nov. Evidence is provided to transfer the monotypic genus Poecopa Bowden, 1956 to the genus Acrapex. Host plants of five species are recorded, some of them for the first time. Acrapex kavumba sp. nov., A. miscantha sp. nov. and A. simillima sp. nov. were found on one host plant each. Acrapex mediopuncta, previously reported in West Africa from Pennisetum purpureum Schumach., Rottboellia compressa L., Setaria megaphylla (Steud) Dur. & Schinz. and Sorghum arundinaceum (Desv.) Stapf, was only found from S. megaphylla in Central Africa. Larvae of Acrapex unicolora were collected on Andropogon gayanus Kunth, Chrysopogon zizanoides (L.) Roberty, Cymbopogon schoenanthus subsp. proximus (Hochst. ex A.Rich.) Maire & Weller, Cymbopogon pospischiilii (K.Schum.) C.E.Hubb., Hyparrhenia diplandra (Hack.) Stapf and Setaria sphacelata (Schumach.) Moss. We also conducted molecular phylogenetic analyses (using maximum likelihood) and molecular species delimitation analyses on a comprehensive sample of 61 specimens belonging to eight of the studied species. Molecular phylogenetic analyses provided additional evidence of the synonymy of Acrapex and Poecopa, whereas molecular species delimitation analyses support the validity of the five newly described species and unravel another potential new species, only collected in the larval stage.