AIDS 2012: HIV/HBV Coinfection Linked to Higher Mortality, More ART Liver Toxicity

Approximately 6% of people with HIV receiving antiretroviral treatment in Tanzania were coinfected with hepatitis B virus (HBV), which was associated with an elevated risk of death, smaller CD4 T-cell gains, and greater likelihood of liver toxicity, researchers reported at the recent XIX International AIDS Conference (AIDS 2012) in Washington, DC. alt

An estimated 6% to 20% of HIV positive people in sub-Saharan Africa are thought to be coinfected with HBV. People with HIV are less likely to spontaneous clear HBV and experience faster progression to advanced liver disease, including cirrhosis and hepatocellular carcinoma. But the effect of HBV coinfection on response to antiretroviral therapy (ART) has not been well studied, especially in Africa.

Claudia Hawkins from Northwestern University and colleagues assessed the prevalence of HBV in a cohort of HIV positive adults at 18 sites in Dar es Salaam who were receiving ART in the PEPFAR-supported Management and Development for Health program. They were followed from November 2004 through September 2011.

Two-thirds of the HIV monoinfected participants and half of the HIV/HBV coinfected patients were women, with an average age of about 36 years. The median CD4 count was low, at about 110 cells/mm3. HIV/HBV coinfected patients who also tested positive for hepatitis C virus were excluded, but only about half were screened. About 17% with HIV alone and 10% with HIV/HBV coinfection were also undergoing treatment for tuberculosis.

All participants were antiretroviral-naive and received a local standard first-line ART regimen consisting of either:

Lamivudine, emtricitabine, and tenofovir are active against HBV as well as HIV, and are therefore preferred drugs for coinfected patients; 3% of HIV monoinfected and 17% of HIV/HBV coinfected patients were on an ART regimen containing tenofovir.


"Antiretroviral treatment outcomes are impacted by the presence of HBV," the researchers concluded, as indicated by lower CD4 counts throughout the course of immune restoration, almost 20% higher risk of mortality, and higher risk of moderate-to-severe hepatotoxicity.



C Hawkins, B Christian, J Ye, et al. Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-positive patients in urban Tanzania. XIX International AIDS Conference (AIDS 2012). Washington, DC, July 22-27, 2012. Abstract MOAB0101.