Response to Antiretroviral Therapy and Survival in HIV/HCV and HIV/HBV Coinfected Patients in Asia

Due to overlapping routes of transmission, many HIV positive individuals are coinfected with the hepatitis B and hepatitis C viruses (HBV and HCV, respectively.

A study presented at the XVI International AIDS Conference, held last week in Toronto, examined rates of coinfection and its impact on response to antiretroviral therapy and survival in Asia.

Researchers from Taiwan analyzed data from 2979 patients in the TREAT Asia HIV Observational Database (TAHOD), which consists of participants from 15 clinics in the Asian-Pacific region.

Results

171 out of 1641 tested patients had positive HBsAg, for an HBV prevalence rate of 10.4%.

153 out of 1469 tested were HCV antibody-positive, for an HCV prevalence rate of 10.4%.

Patients with either HBV or HCV had a smaller CD4 cell increase after starting antiretroviral therapy, but the difference was not statistically significant.

Patients achieved undetectable HIV viral load (< 400 copies/mL) in a mean 148 days after starting antiretroviral therapy; this, too, was not significantly different between patients with or without HBV or HCV.

By univariate analysis, HIV/HCV coinfected patients had an increased mortality rate (unadjusted hazard ratio [HR] 2.77; P = 0.008).

However, neither HBV nor HCV coinfection were associated with increased mortality after adjusting for baseline CD4 count, HIV viral load, receipt of antiretroviral therapy, and HIV disease stage (adjusted HR 0.82; 95% CI 0.25-2.69; P = 0.745 and HR 1.55; 95% CI 0.66-3.68; P = 0.317, respectively).

The small number of patients triply infected with HIV, HBV, and HCV had no significant differences in antiretroviral treatment response or mortality compared to those with HIV/HBV or HIV/HCV coinfection.

HIV/HBV coinfection patients had a marginally higher rate of elevated alanine aminotransferase (ALT), and HIV/HCV coinfected patients had significantly more ALT elevation.

Coinfected patients experienced more toxicity related to antiretroviral drugs.

Conclusion

In conclusion, the researchers wrote, "No significant differences in terms of immunological and virological response to antiretroviral [combination therapy] were seen between patients with or without hepatitis. Overall survival was also similar in coinfected patients."

8/25/06

Reference
J Zhou, G Dore, Y-M A Chen, and others. Hepatitis B and C virus coinfection among patients with HIV in treat Asia HIV observational database. XVI International AIDS Conference. Toronto, August 13-18, 2006. Abstract TUAB0302.