Characterization of HIV–HBV coinfection in a multinational HIV-infected cohort

• DOI: 10.1097/qad.0b013e32835a9984
• Publication Date: 2012-10-02T07:31:16Z
• Authors: Chloe L. Thio; Laura Smeaton; Melissa Saulynas; Hyon Hwang; Shanmugam Saravan; Smita Kulkarni; James Hakim; Mulinda Nyirenda; Hussain S. Iqbal; Umesh G. Lalloo; Anand S. Mehta; Kimberly Hollabaugh; Thomas B. Campbell; Shahin Lockman; Judith S. Currier
• Keywords: Adult; Male; Hepatitis B Surface Antigens; Coinfection; HIV Infections; Viral Load; Hepatitis B; Antiviral Agents; CD4 Lymphocyte Count; 3. Good health; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Antiretroviral Therapy, Highly Active; Humans; Regression Analysis; Female; Randomized Controlled Trials as Topic

To understand the HIV-hepatitis B virus (HBV) epidemic from a global perspective by clinically and virologically characterizing these viruses at the time of antiretroviral therapy (ART) initiation in a multinational cohort.HIV-infected patients enrolled in two international studies were classified as HIV-HBV coinfected or HIV monoinfected prior to ART. HIV-HBV coinfected patients were tested for HBV characteristics, hepatitis D virus (HDV), a novel noninvasive marker of liver disease, and drug-resistant HBV. Comparisons between discrete covariates used χ or Fisher's exact tests (and Jonchkheere-Terpstra for trend tests), whereas continuous covariates were compared using Wilcoxon Rank-Sum Test.Of the 2105 HIV-infected patients from 11 countries, the median age was 34 years and 63% were black. The 115 HIV-HBV coinfected patients had significantly higher alanine aminotransferase and aspartate aminotransferase values, lower BMI, and lower CD4 T-cell counts than HIV monoinfected patients (median 159 and 137 cells/μl, respectively, P = 0.04). In the coinfected patients, 49.6% had HBeAg-negative HBV, 60.2% had genotype A HBV, and 13% were HDV positive. Of the HBeAg-negative patients, 66% had HBV DNA 2000 IU/ml or less compared to 5.2% of the HBeAg-positive individuals. Drug-resistant HBV was not detected.Screening for HBV in HIV-infected patients in resource-limited settings is important because it is associated with lower CD4 T-cell counts. In settings in which HBV DNA is not available, HBeAg may be useful to assess the need for HBV treatment. Screening for drug-resistant HBV is not needed prior to starting ART in settings in which this study was conducted.