HIV and Hepatitis.com Coverage of the
13th Annual Conference on Retroviruses and Opportunistic Infections
February 5 - 8, 2006, Denver, CO

Survival Outcomes among HIV-HBV Coinfected Patients on HAART 

By Marina Nunez, MD, PhD

The survival of HIV-HBV coinfected patients was examined within the HIV Atlanta Veterans Affairs Cohort Study (HAVACS). The authors of the present work assessed three different end-points (liver disease, survival from HIV infection to death and survival from AIDS to death) in the study population, classified into four groups: chronic HBV (positive HBsAg, n= 157), isolated core antibody to HBV (no other serological markers, n= 203), resolved or vaccinated HBV (anti-HBs antibody positive ± core antibody, n= 286), and no HBV (all serologies negative, n= 700).

As expected, both HBV and HCV infections were associated with a 3-fold higher risk of liver disease (p=0.02). On the contrary, patients with isolated core antibody were not more likely to have liver disease, and had similar survival than those with resolved HBV infection.

Survival both from HIV infection and from AIDS to death did not significantly differ in HBV coinfected patients compared to the remaining patients. However, as the table below shows, the use of HAART, and particularly of 3TC and TDF, exerted a protective effect at any stage of HIV disease, with significant decreases in the risk of death. HCV coinfection was a predictor of death in patients with advanced HIV infection.

Hazard ratios for survival: multivariate analyses.

HR (p) for survival from
AIDS to death
HR for survival from
HIV infection to death

Chronic HBV

1.43 (p=0.12)

1.28 (p=0.27)

Isolated core antibody

0.86 (p=0.52)

____

HCV+

1.62 (p=0.008)

____

Risk factor for HIV

      IVDU vs. homosexual

      Other vs. homosexual

____

1.44 (p=0.046)

1.52 (p=0.009)

Alcohol

0.63 (p=0.01)

____

HAART use

0.40 (p=0.0003)

0.51 (p=0.004)

3TC use

0.36 (p<0.0001)

0.54 (p=0.009)

TDF use

0.23 (p<0.0001)

0.27 (p<0.0001)

First ALT

       41-100 IU/mL

       >100 IU/mL

____

1.54 (p=0.003)

1.74 (p=0.01)

First CD4 count 51-200 cells/mm3

____

1.85 (p=0.03)



While the study does not include relevant information such as HBV DNA and HCV RNA viremia and HBeAg status, these findings suggest that HAART including anti-HBV drugs confers a benefit in survival to patients with HIV-HBV coinfection. In addition, this study adds evidence to the concept of lack of association between past exposure to HBV and liver disease.

02/21/06

Reference
M Osborn and others. Survival in HIV/HBV coinfected patients in the era of HAART. 13th Conference on Retroviruses and Opportunistic Infections. February 5-8, 2006, Denver, CO. Abstract 833.