Researchers with the Multicenter
AIDS Cohort Study (MACS) looked at HIV suppression, CD4 cell recovery, and
rates of death among 822 participants who initiated antiretroviral therapy; 354
were never infected with HBV (HBcAb negative),
359 had evidence of past cleared HBV infection (HBsAb
and HBcAb positive), 45 had chronic hepatitis B (HBsAg positive at 2 visits),
and 64 had possible occult HBV infection (HBcAb positive only).
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 and HBcAb positive only groups compared with
never-infected subjects.
•
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 or CD4 cell recovery across the 4 HBV infection
categories.
"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,"
the researchers wrote.
HIV-HBV in South Africa
In
parts of Africa and Asia, chronic HBV coinfection is estimated to occur in 10%-20%
of HIV positive individuals. Researchers in South Africa evaluated the effect
of HBV infection on HIV virological response, CD4 cell recovery, hepatotoxicity,
and death among a cohort of patients receiving anti-HIV treatment.
They
prospectively studied 537 patients in a multi-site workplace cohort during the
first 72 weeks on antiretroviral therapy consisting of AZT
(zidovudine, Retrovir), 3TC
(lamivudine, Epivir), and efavirenz
(Sustiva). Subjects were stratified as hepatitis B surface antigen (HBsAg)
positive or negative and with high or low HBV DNA (above or below 104 copies/mL).
Results
•
431 patients (80.2%) were HBsAg negative.
•
60 (11.2%) had low HBV DNA and 46 (8.6%) had
high HBV DNA.
•
All groups had similar HIV viral load suppression
and CD4 cell gains during 72 weeks on HAART.
•
Baseline liver enzyme (ALT and AST) levels
were higher in the high HBV DNA group compared with the other 2 groups
•
Hepatotoxicity risk was similar between the
HBsAg negative and low HBV DNA groups, but higher for the high HBV DNA group.
Based
on these findings, the investigators concluded, "We have shown that HBV status
does not affect HIV RNA suppression or CD4 response during the first 72 weeks
of HAART in an African setting."
But,
they added, "this is the first study to demonstrate that risk of HBV-associated
hepatotoxicity is associated with baseline HBV DNA level."
HIV-HBV
in South Africa
Finally, another team of researchers tested
the hypothesis that high HBV DNA levels would influence pre-HAART HIV disease
stage and antiretroviral hepatotoxicity, but would not affect antiretroviral response.
This study included 1305 HIV monoinfected and 264 HIV-HBV coinfected patients
without hepatitis C who started HAART in Nigeria. Here, too, patients were stratified
by HBsAg status and high or low HBV DNA (above or below (20,000 IU/ml). Comparisons
were made at baseline and after months 3 and 6 on antiretroviral therapy.
Results
•
The median baseline CD4 count was lower in
the HIV-HBV coinfected group with high HBV DNA compared with the HIV monoinfected
and coinfected low HBV DNA groups (89, 130, and 129 cells/mm3, respectively).
•
Stratification by HBeAg status revealed that
the median baseline CD4 count in HBeAg negative low HBV DNA patients was similar
to that of the HIV monoinfected group (129 and 130 cells/mm3, respectively); all
other groups had lower median baseline counts.
•
The median baseline HIV RNA level was similar
between the HIV-HBV coinfected groups with high and low HBV DNA (89,882 and 96,895
copies/mL, respectively), which was significantly higher than that of the HIV
monoinfected group (55,708 copies/mL).
•
After 6 months on antiretroviral therapy,
neither HBV DNA level nor HBeAg status altered the percentage of patients who
suppressed HIV RNA below 400 copies/mL.
•
CD4 counts increased in all groups at 6 months,
but those with high HBV
•
DNA had lower median CD4 counts (216 vs 229
cells/mm3 for low HBV DNA and 240 cells/mm3 for HIV only); HBeAg status did not
alter this relationship.
•
The high HBV DNA group had significantly higher
median baseline ALT and the greatest cumulative rate of hepatotoxicity by month
6 (12% vs 4%-5%).
"In
this HIV-HBV coinfected Nigerian cohort, high HBV DNA levels were associated with
lower baseline CD4 counts and increased risk for hepatotoxicity on antiretroviral
therapy," the researchers concluded. "High HBV DNA levels did not clearly
impair immunological and virological responses with 6 months of antiretroviral
therapy, but CD4 counts remained lower in those with high HBV DNA."
Hepatitis
B Coinfection Does Not Impact HIV Suppression or CD4 Cell Recovery on HAART
Results
In
parts of Africa and Asia, chronic HBV coinfection is estimated to occur in 10%-20%
of HIV positive individuals. Researchers in South Africa evaluated the effect
of HBV infection on HIV virological response, CD4 cell recovery, hepatotoxicity,
and death among a cohort of patients receiving anti-HIV treatment.
