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Hepatitis B Coinfection Does Not Interfere with Response to Antiretroviral Therapy

By Liz Highleyman

Some research indicates that individuals coinfected with HIV and hepatitis B virus (HBV) may experience worse liver disease progression, but there has been little study of the impact of HBV on HIV disease progression and response to antiretroviral treatment.

In the May 2008 issue of HIV Medicine, Danish investigators described the results of a prospective cohort study that included all 3180 adult HIV-infected patients in Denmark who started HAART between January 1995 and December 2006.

Patients were classified as having chronic HBV infection (6%), being HBV negative (87%), or having unknown HBV status (7%). The HBV positive patients were further divided into hepatitis B "e" antigen (HBeAg) positive (3.0%) and HBeAg negative (2.6%) groups. Study endpoints were HIV viral load, CD4 cell count, and mortality.

Results

• HBV coinfection had no impact on response to HAART with regard to either HIV viral suppression or immune recovery.

• However, HIV-HBV coinfection was associated with several negative outcomes:

• Higher overall mortality (mortality rate ratio [MRR] 1.5);
• Higher liver-related mortality (MRR 4.0);
• Higher rate of AIDS-related death (MRR 1.7).

• HBeAg status did not influence response to HAART.

Conclusion

In conclusion, the researchers wrote, "In HIV patients, chronic HBV infection has no impact on response to HAART concerning viral load and increase in CD4 cell count."

However, they added, "co-infected patients have an increased mortality compared to HIV-monoinfected patients."

Rigshospitalet, Copenhagen, Denmark; Hvidovre Hospital, Copenhagen, Denmark; Aarhus University Hospital, Denmark; Odense University Hospital, Denmark; Aalborg Hospital, Denmark; Kolding Hospital, Denmark; Boston University, MA.

4/15/08

Reference
LH Omland, N Weis, P Skinhoj, and others. Impact of hepatitis B virus co-infection on response to highly active antiretroviral treatment and outcome in HIV-infected individuals: a nationwide cohort study. HIV Medicine 9(5): 300-306. May 2008.