As reported at the 15th Conference
on Retroviruses and Opportunistic Infections this week in Boston, researchers
with the long-term prospective observational Multicenter AIDS Cohort Study (MACS)
looked at response to antiretroviral therapy (HIV suppression and immunological
recovery), as well as rates of death, among HIV-HBV coinfected men compared to
those with HIV alone.
The analysis included 822 MACS participants who initiated
antiretroviral therapy after enrollment and had enough HBV serology information
to determine their infection status. The median patient age was 34 years and the
median follow-up period was 8.5 years. Based on HBV serology tests, participants
were stratified into 4 categories:
•
Never infected with HBV (HBcAb negative) (n=354);
•
Cleared past HBV infection (HBsAb and HBcAb
positive) (n=359);
•
Chronic hepatitis B (HBsAg positive at 2 separate
visits) (n=45);
•
HBcAb positive only (possible occult HBV infection)
(n=64).
All-cause
mortality, AIDS-related-mortality, and non-AIDS-related mortality (including liver-related
death) were modeled using survival analysis. HIV RNA suppression was modeled using
generalized estimating equations, and CD4 cell recovery was modeled using mixed
linear equations.
Results
•
Of the 64 HBcAb positive only participants,
7 had detectable HBV DNA.
•
The risk of AIDS-related death was not increased
in any of the 4 HBV infection status groups.
•
However, rates of non-AIDS-related death were
higher in the chronic hepatitis B (HR 6; P = 0.009) and HBcAb positive only (HR
4; P = 0.05) groups compared with never infected subjects, after adjusting for
age, CD4 cell count, and pre-treatment HIV viral load.
•
Of 6 deaths among HBsAg positive chronic hepatitis
B patients, 4 were liver-related.
•
By contrast, none of the 4 deaths in the HBcAb
positive only group were liver-related.
•
In adjusted models, there was no observed
difference in HIV RNA suppression (P = 0.6) or CD4 cell recovery (P = 0.08) across
the 4 HBV infection status categories.
Conclusion
In
conclusion, the investigators wrote, "In this well-characterized, prospectively
followed cohort receiving long-term antiretroviral therapy, past or present infection
with HBV did not alter the long-term immunological response to antiretroviral
therapy as measured by HIV RNA suppression or CD4 response."
However,
they added, "liver-related deaths were higher in persons with chronic HBV
and non-AIDS mortality was significantly higher in HBcAb positive only subjects.
Johns Hopkins Univ School of Medicine, Baltimore, MD; Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD; Univ of Pittsburgh School of
Public Health, PA; David Geffen School of Medicine, Univ of California, Los Angeles,
CA; Feinberg School of Medicine, Northwestern Univ, Chicago, IL.
2/5/08
Reference C
Hoffmann, E Seaberg, K D'Acunto, and others. Death, HIV Suppression, and CD4 Recovery
among HIV/HBV-co-infected Men Receiving ART: MACS. 15th Conference on Retroviruses
and Opportunistic Infections. Boston, MA. February 3-6, 2008. Abstract 1029.
Benefits
of HAART and Outcomes among HIV-HBV Coinfected Men 
