Coinfection

IAS 2013: People with HBV or HCV Coinfection May Not Respond as Well to HIV Treatment

HIV positive people with hepatitis B or C coinfection in Asia had lower CD4 T-cell counts, saw smaller CD4 cell gains after starting antiretroviral therapy, and had a higher risk of death, researchers reported at the recent 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Kuala Lumpur.

Coinfection with HIV is associated with faster liver disease progression among people with hepatitis B or C, as well as poorer response to interferon-based hepatitis C treatment. Studies of the effect of hepatitis B or C on HIV disease progression have been less consistent, but most have seen little effect, especially among people on effective antiretroviral therapy (ART).

Yi-Ming Arthur Chen from Kaohsiung Medical University in Taiwan and colleagues looked at the effects of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on long-term outcomes following ART initiation among people in the Asia-Pacific region, where hepatitis B is highly endemic and hepatitis C is common.

The study included 7455 HIV positive patients from 21 hospitals in 12 Asian countries included in the TREAT Asia HIV Observational Database (TAHOD), who collectively contributed 24,798 total person-years of follow-up. People who had ever tested positive for hepatitis B surface antigen (HBsAg) or anti-HCV antibodies were considered coinfected.

Results

• Overall, among people with available test results, hepatitis B prevalence was about 10% and hepatitis C prevalence was about 15%.
• Among patients with available CD4 counts at baseline and 6 months after ART initiation, the mean increase was +122 cells/mm³.
• HIV/HCV coinfected patients had significantly smaller CD4 gains than people with HIV alone, with a mean increase of +90 cells/mm³.
• The increase was also smaller for HIV/HBV coinfected people (+110 cells/mm³), but the difference was not statistically significant.
• Older age, lower baseline CD4 count (excluding the small proportion who started ART with >350 cells/mm³), higher baseline HIV viral load, HIV subtypes other than B, and history of injection drug use also predicted smaller CD4 cell gains.
• Among participants with HIV viral load measurements at baseline and 1 year or more after starting ART, 97% reached a viral load below 1000 copies/mL, which took a median of 1.28 years.
• People with HIV/HBV or HIV/HCV coinfection were equally likely to achieve viral load below 1000 copies/mL (98% and 96%, respectively).
• Coinfected patients took slightly longer to reach this viral load target (1.33 for HIV/HBV and 1.38 for HIV/HCV), but the differences were not significant.
• Looking at survival, the overall mortality rate was 1.22 per 100 person-years, rising to 1.48 for people with HIV/HBV coinfection and 2.53 for those with HIV/HCV coinfection.
• In a multivariate analysis, HIV/HCV coinfected people had significantly increased mortality (adjusted hazard ratio [HR] 1.8, or 80% higher).
• HIV/HBV coinfected people had a slight increase in mortality, but again the difference did not reach statistical significance (adjusted HR 1.3, or 30% higher).
• Patients with either HIV/HBV or HIV/HCV coinfection had significantly worse survival curves compared with non-coinfection individuals.
• Neither HIV/HBV nor HIV/HCV coinfection was associated with HIV viral load.

"In this Asian regional HIV cohort, patients with HBV or HCV coinfection had significantly lower CD4 counts [and] smaller CD4 increases after 180 days of ART," the researchers concluded.

"We need to test, identify, and initiate [highly active] ART early in HBV and HCV coinfected [patients] to have a better treatment effect," they recommended.

8/7/13

Reference

Y-MA Chen, Y-H Chen, Y-T Lin, et al. HBV and HCV co-infection: long term immunological, virological and survival outcomes following cART. 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013. Abstract TULBPE13.