Low
CD4s, Interferon Therapy, and Hepatitis Delta Impair Health-related Quality of
Life for HIV-HBV Coinfected Patients
By
Liz Highleyman Due
to overlapping transmission routes, many individuals have been exposed to both
HIV and hepatitis B virus (HBV), and
an estimated 4 million HIV positive people worldwide have chronic
hepatitis B coinfection. This population has not been extensively studied,
and little is known about their health-related quality of life (HRQL).
As
described in a poster presented at the 16th Conference
on Retroviruses and Opportunistic Infections (CROI 2009) this month in Montreal,
Fabienne Marcellin, Karine Lacombe, and colleagues used data from a French cohort
to analyze HRQL among 273 HIV-HBV coinfected patients. At
study enrollment, the median age was 39 years. A majority (60%) had been diagnosed
with hepatitis B prior to 1996, and 57% were hepatitis B "e" antigen
(HBeAg) positive. In addition to HIV and HBV, 6% each also had hepatitis
C virus (HCV) and hepatitis
delta virus (HDV). HDV is a defective RNA virus that cannot replicate on its
own, but requires the presence of HBV. Participants
completed a brief HRQL questionnaire investigating 6 different dimensions, first
at entry into the cohort and then at each quarterly visit during the 3-year follow-up
period. The researchers calculated 6 binary scores (good versus impaired HRQL),
and these were used to derive a global HRQL score ranging from 0 to 25, with higher
values indicating poorer quality of life. Results
The median global HRQL score was 11.
184 patients (31%) reported poor overall health.
No significant changes in HRQL were observed over time.
In a multivariate analysis, low CD4 percentage and treatment with interferon were
independently associated with both poorer global HRQL and poor overall health.
HIV diagnosis before 1996 was associated with poorer global HRQL.
HDV infection was associated with poor overall health.
These
findings led the investigators to conclude that, "HRQL of patients living
with HIV and chronic HBV infection is strongly linked to patients' immune status
and experience with treatments." "Patients
with HDV infection and those with HBeAg positive status require special attention,"
they added. "Further therapeutic research is needed on HDV infection to improve
patient care." 2/24/09 Reference
F
Marcellin, K Lacombe, L Fugon, and others. Health-related Quality of Life of HIV-infected
Patients with Chronic HBV Infection: a 3-year Longitudinal Analysis. 16th Conference
on Retroviruses and Opportunistic Infections (CROI 2009). Montreal, Canada. February
8-11, 2009. Abstract 819. | 
