CD4 Cell Count Linked to Hepatitis B Surface Antigen
Loss in HIV/HBV Coinfected Patients
Loss of hepatitis B surface antigen (HBsAg)
-- an indicator of hepatitis B virus (HBV)
control by the immune system or successful
treatment -- is more likely to occur in
HIV/HBV coinfected individuals who maintain
a high CD4 cell count, according to a retrospective
analysis reported in the March
7, 2010 World Journal of Gastroenterology.
This finding supports the recommendation
that HIV/HBV coinfected patients may benefit
from earlier initiation of antiretroviral
therapy (ART), while immune function is
still relatively intact.
is the text of a press release from the World Journal
of Gastroenterology describing the study and its findings.
Predictors of Loss of Hepatitis B Surface Antigen
in Patients Co-Infected with HIV and HBV
March 30, 2010 -- Co-infection with human immunodeficiency
virus (HIV) and hepatitis B virus (HBV) poses a treatment
challenge. In Western Europe and the United States,
chronic HBV infection has been found in 6%-14% of
HIV positive patients and this co-infection is well
known to be associated with increased liver-related
morbidity and mortality. However, factors associated
with HBV surface antigen (HBsAg) loss in HIV and HBV
co-infected patients remain unclear.
A research article to be published on March 7, 2010
in the World Journal of Gastroenterology addresses
this question. The research team from St. Luke's-Roosevelt
Hospital Center, New York City, USA, performed a retrospective
chart review of 5681 patients followed up at St. Luke's-Roosevelt
Hospital HIV clinic (the Center for Comprehensive
Care) in New York City from Jan 1999 to May 2007.
HIV and HBV co-infection was defined as positive HIV
infection and HBsAg serology.
The authors compared patients with HBsAg loss to the
rest of the cohort at baseline and at time of loss
of HBsAg. Clinical and laboratory parameters including
baseline and follow-up HIV viral loads, CD4 cell counts,
alanine aminotransferase (ALT) levels, HCV co-infection,
demographics, and duration of anti-HBV therapy were
analyzed to determine factors associated with loss
Of the 5681 HIV infected patients in the cohort, 355
patients were HIV and HBV co-infected and were evaluated.
Of these, 226 patients with more than 12 months follow-up
were included in the further analysis to better estimate
factors associated with loss of HBsAg in the long-term
follow-up. The patients were observed for a mean duration
of 45.6 months (range, 20.8 - 61.1 months). During
the follow-up period, 21 patients lost HBsAg.
In the univariate analysis, baseline CD4 cell count
was associated with loss of HBsAg (P = 0.052). Other
factors, including baseline ALT, presence of hepatitis
C virus co-infection, baseline HIV viral load, HIV
viral load at end of follow-up, CD4 cell count at
end of follow-up, CD4 cell count gain, and treatment
with dually active antiretrovirals were not related
to loss of HBsAg.
Cox regression analysis revealed that baseline CD4
cell count > 500 cells/mm3 was associated with
loss of HBsAg.
The study showed an interesting association of HBsAg
loss in HIV-HBV co-infected patients with higher CD4
cell count, suggesting that T-cell cytolytic activity
against HBV may still be effective in clearing HBV
Center for Comprehensive Care, Division of Infectious
Diseases, St. Luke's-Roosevelt Hospital Center, New
York, NY; Division of Infectious Diseases, University
of Pittsburgh Medical Center, Pittsburgh, PA; Center
for Comprehensive Care, St. Luke's-Roosevelt Hospital
Center, New York, NY.
G Psevdos, JH Kim, JS Suh, and VL Sharp. Predictors
of loss of hepatitis B surface antigen in HIV-infected
patients. World Journal of Gastroenterology 16(9):
full text). March 7, 2010.
Journal of Gastroenterology. Predictors of loss
of hepatitis B surface antigen in patients co-infected
with HIV and HBV. Press release. March 30, 2010.