Coinfection

HIV/HBV Coinfection Raises Risk of AIDS Progression and Death

Coinfection with hepatitis B virus (HBV) nearly doubled the risk of progression to AIDS or death among people recently infected with HIV, according to a study described in the December 5, 2011, advance online edition of the Journal of Infectious Diseases.

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Due to overlapping risk factors (including shared drug injection equipment and sexual transmission), coinfection with HIV and HBV is common; an estimated 5%-10% of people with HIV have chronic hepatitis B, but as many as three-quarters or more show evidence of past infection that has since resolved.

A considerable body of research shows that HIV positive people with hepatitis B or C coinfection experience worse liver disease progression, but the effect of HBV on HIV disease progression is not well understood.

Helen Chun from the Uniformed Services University of the Health Sciences and colleagues retrospectively analyzed the impact of HBV coinfection on HIV-related disease progression in a cohort of 2352 military personnel with a known HIV seroconversion window during the past 3 years.

Within this group, 1732 people (73.6%) were HBV negative with no evidence of current or past infection, 474 (20.0%) had resolved hepatitis B, 82 (3.5%) had only antibodies against hepatitis B core antigen (HBcAb), and 64 (2.7%) had chronic hepatitis B. The resolved and HBcAb groups showed evidence of prior exposure to HBV but not chronic or persistent infection.

Results

  • A total of 305 participants progressed to AIDS and 164 died during approximately 17,000 person-years of follow-up.
  • People with chronic hepatitis B were more likely to progress to clinical AIDS or death than individuals with resolved HBV or isolated HBcAb, who in turn were more likely than people without evidence of HBV infection.
  • In an unadjusted analysis, combined rates of clinical AIDS or death were as follows:
    • HBV negative: 2.43;
    • Resolved HBV infection: 3.27;
    • Isolated HBcAb: 3.75;
    • Chronic hepatitis B: 5.41.
  • In a multivariate analysis controlling for confounding factors, risk of AIDS or death was significantly higher for people with chronic hepatitis B compared with the HBV negative group (hazard ratio [HR] 1.80, or nearly 2-fold higher risk).
  • People with resolved HBV infection or isolated HBcAb also had a somewhat higher risk than uninfected individuals (HR 1.17 and 1.14, respectively), but the difference did not reach statistical significance.
  • The risk of AIDS or death remained elevated after the advent of effective combination antiretroviral therapy, even though a majority of patients used drugs active against both HIV and HBV (e.g., lamivudine [Epivir], emtricitabine [Emtriva], tenofovir [Viread]).

"HBV coinfection has a significant impact on HIV outcomes," the study authors summarized. "The hazard for an AIDS or death event is almost double for those  with chronic hepatitis B compared, with HIV-monoinfected persons."

In an accompanying editorial, Philip Peters and Barbara Marston from the U.S. Centers for Disease Control and Prevention (CDC) concluded that this study “adds to the weight of evidence that coinfection is deleterious," emphasizing the need for "additional steps to combat hepatitis B now,” including more extensive HBV screening and vaccination.

Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; Division of Infectious Diseases, National Naval Medical Center, Bethesda, MD; Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD; Division of Retrovirology, Walter Reed Army Institute of Research, Silver Spring, MD; Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, CA; Infectious Disease Clinic, Naval Medical Center, San Diego, CA; Division of Biostatistics, University of Minnesota, MN; Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC; Division of Infectious Diseases, Naval Medical Center, Portsmouth, VA; Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX.

12/13/11

References

HM Chun, MP Roediger, KH Hullsiek, et al. Hepatitis B Virus Coinfection Negatively Impacts HIV Outcomes in HIV Seroconverters. Journal of Infectious Diseases. December 5, 2011 (Epub ahead of print).

PJ Peters and BJ Marston. PreventingDeaths in Persons With HIV/Hepatitis B Virus Coinfection: A Call to Accelerate Prevention and Treatment Efforts. Journal of Infectious Diseases. December 5, 2011 (Epub ahead of print).