HIV-HBV Coinfected Patients Respond to Antiretroviral Therapy as well as HIV Monoinfected, but Have a Higher Risk of Non-AIDS Death

HIV positive people coinfected with hepatitis B virus (HBV) respond as well to combination antiretroviral therapy (ART) as individuals with HIV alone, but they are more likely to die due to non-AIDS-related causes, according to a study published in the September 10, 2009 issue of AIDS.

Due to overlapping routes of infection, many people are coinfected with both HIV and HBV, and an estimated 5% to 10% have chronic coinfection. Some commonly used antiretroviral drugs -- including tenofovir (Viread, also in the Truvada and Atripla combination pills), emtricitabine (Emtriva), and lamivudine (3TC, Epivir) -- are active against both viruses. But long-term ART outcomes in this group have not been extensively studied.

Christopher Hoffmann from Johns Hopkins Medical School and colleagues retrospectively analyzed data from participants in the Multicenter AIDS Cohort Study (MACS), a longitudinal study of men who have sex with men in Baltimore, Chicago, Pittsburgh, and Los Angeles.

Study participants were classified according to hepatitis B status based on serology findings at the time of combination ART initiation. Of 816 men followed for a median of 7 years on ART, 350 were never infected with HBV, 357 had evidence of past infection, 45 had chronic hepatitis B, and 64 were only hepatitis B core antibody (HBcAb) positive.

The investigators used regression analysis to determine associations between chronic hepatitis B and HIV suppression, CD4 cell gain, AIDS-defining illnesses, and mortality.

Results

"In HIV-infected patients receiving long-term HAART, HBV status did not influence HIV suppression or CD4 cell increase," the investigators concluded. "However, mortality was highest among those with chronic hepatitis B and was mostly due to liver disease despite HBV-active HAART."

Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of New Mexico School of Medicine, Albuquerque, NM; David Geffen School of Medicine at UCLA, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA; Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL.

9/04/09

Reference

CJ Hoffmann, EC Seaberg, S Young, and others. Hepatitis B and long-term HIV outcomes in coinfected HAART recipients. AIDS 23(14): 1881-1889. September 10, 2009. (Abstract).