Coinfected Patients Respond to Antiretroviral Therapy as well as HIV Monoinfected,
but Have a Higher Risk of Non-AIDS Death
positive people coinfected with hepatitis B virus (HBV) respond as well to combination
antiretroviral therapy (ART) as individuals with HIV alone, but they are more
likely to die due to non-AIDS-related causes, according to a study published in
10, 2009 issue of AIDS.|
to overlapping routes of infection, many people are coinfected
with both HIV and HBV, and an estimated 5% to 10% have chronic coinfection.
Some commonly used antiretroviral
drugs -- including tenofovir (Viread,
also in the Truvada and Atripla
combination pills), emtricitabine (Emtriva),
and lamivudine (3TC, Epivir) --
are active against both viruses. But long-term ART outcomes in this group have
not been extensively studied.
Hoffmann from Johns Hopkins Medical School and colleagues retrospectively analyzed
data from participants in the Multicenter AIDS Cohort Study
(MACS), a longitudinal study of men who have sex with men in Baltimore,
Chicago, Pittsburgh, and Los Angeles.
participants were classified according to hepatitis B status based on serology
findings at the time of combination ART initiation. Of 816 men followed for a
median of 7 years on ART, 350 were never infected with HBV, 357 had evidence of
past infection, 45 had chronic hepatitis B, and
64 were only hepatitis B core antibody (HBcAb) positive.
investigators used regression analysis to determine associations between chronic
hepatitis B and HIV suppression, CD4 cell gain, AIDS-defining illnesses, and mortality.
87 patients died while on combination ART, for a mortality rate of 17 deaths per
1000 person-years (PY).|
being on ART, AIDS-related illness was the most common cause of death (8 deaths
per 1000 PY). |
AIDS-related mortality rate was highest among patients with chronic hepatitis
B (17 per 1000 PY).|
with past HBV infection had an intermediate AIDS-related mortality rate (14 per
AIDS-related death rate was lowest among people who had never been infected with
HBV (3 per 1000 PY). |
a multivariable model adjusting for potential confounding factors including time
of ART initiation and history of injection drug use, patients with chronic hepatitis
B had a 2.7-fold higher rate of AIDS-related mortality than those who were never
infected, a difference that did not reach statistical significance (P = 0.08).
rate of non-AIDS-related mortality also was highest among participants with chronic
hepatitis B (22 per 1000 PY), primarily due to liver disease, and this was significant
(adjusted hazard ratio 4.1; P = 0.04). |
non-AIDS death rate was likewise lowest for individuals never infected with HBV
(2 per 1000 person-years).|
of the 6 non-AIDS deaths in the chronic hepatitis B group were liver-related,
a rate of 17 per 1000 PY. |
were no significant differences in HIV viral load suppression, CD4 cell increases,
or AIDS-defining events.|
HIV-infected patients receiving long-term HAART, HBV status did not influence
HIV suppression or CD4 cell increase," the investigators concluded. "However,
mortality was highest among those with chronic hepatitis B and was mostly due
to liver disease despite HBV-active HAART."
of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD; Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD; University of New Mexico
School of Medicine, Albuquerque, NM; David Geffen School of Medicine at UCLA,
Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA; Department
of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School
of Public Health, Pittsburgh, PA; Division of Infectious Diseases, Northwestern
University Feinberg School of Medicine, Chicago, IL.
Hoffmann, EC Seaberg, S Young, and others. Hepatitis B and long-term HIV outcomes
in coinfected HAART recipients. AIDS 23(14): 1881-1889. September 10, 2009. (Abstract).