Objective
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 multi-national cohort.
Methods and design
HIV-infected subjects enrolled in two international studies were classified as HIV-HBV co-infected or HIV monoinfected prior to ART. HIV-HBV co-infected subjects were tested for HBV characteristics, hepatitis D virus (HDV), a novel non-invasive marker of liver disease, and drug-resistant HBV. Comparisons between discrete covariates used chi-square or Fisher’s exact tests (and Jonchkheere-Terpstra for trend tests) while continuous covariates were compared using Wilcoxon Rank-Sum Test.
Results
Of the 2105 HIV-infected subjects from 11 countries, the median age was 34 years and 63% were Black. The 115 HIV-HBV co-infected subjects had significantly higher ALT and AST values, lower body mass index, and lower CD4+ T-cell counts than HIV monoinfected subjects (median 159 cells/mL and 137 cells/mL, respectively, P=0.04). In the co-infected subjects, 49.6% had HBeAg-negative HBV, 60.2% had genotype A HBV, and 13% were HDV positive. Of the HBeAg-negative subjects, 66% had HBV DNA ≤2000 IU/ml compared to 5.2% of the HBeAg-positive subjects. Drug-resistant HBV was not detected.
Conclusions
Screening for HBV in HIV-infected patients in resource-limited settings is important since it is associated with lower CD4+ T-cell counts. In settings where 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 where this study was conducted.
Background: Obstructive sleep apnea (OSA) is a reasonably common disorder that is associated with daytime tiredness and a host of medical conditions. Little is known about how primary care clinicians (PCCs) detect, diagnose, and manage patients who have OSA.Methods: We gathered information from 44 randomly selected practices in 5 regional practice-based research networks. This included interviews with PCCs and sleep consultants, medical records abstraction, and patient surveys. Descriptive analyses of the quantitative data were used to describe the prevalence of sleep symptoms, the proportion of primary care patients at high risk for OSA, and the methods used by PCCs to detect and diagnose patients with OSA.Results
Objective
To explore the relationship between HCV/HIV co-infection and responses to initial antiretroviral treatment (ART)
Methods
Four AIDS Clinical Trials Group HIV treatment studies' data were combined to compare initial ART responses between HCV/HIV co-infected and HIV mono-infected patients as evaluated by virologic failure, CD4 measures, occurrence of AIDS/death and Grade 3/4 safety events, using Kaplan-Meier estimates and proportional hazard, regression and mixed effects models, adjusting for baseline covariates.
Results
Of the 3041 included subjects, 81% were male, 19% had prior history of AIDS, the median (25th, 75th percentile) baseline HIV RNA was 4.72 (4.38, 5.18) log10 copies/mL and the median (25th, 75th percentile) baseline CD4 was 216.0 (76.5, 327.0) cells/μL. The 279 HCV/HIV co-infected were older (44 vs. 37 years), more likely to be black non-Hispanic (47% vs. 36%) and history/current intravenous drug user (52% vs. 5%) than the 2762 HIV mono-infected subjects (All P-values < 0.001). HCV/HIV co-infection was associated with earlier virologic failure, hazard ratio (HR) (95% confidence interval): 1.43 (1.07, 1.91); smaller mean CD4 increase and CD4% increase (-33.8 (-52.2, -15.4) cells/μL and -1.16% (-1.43%, -0.89%), respectively) over a median of 132 weeks follow-up; earlier occurrence of Grade 3/4 safety event, HR 1.51 (1.26, 1.81); and increased AIDS/mortality, HR 2.10 (1.31, 3.37). Treatment effects comparing antiretroviral regimens were not significantly different by HCV/HIV co-infection status.
Conclusions
HCV/HIV co-infection is associated with attenuated response to ART. Results support earlier initiation of HIV therapy and increased monitoring of those initiating ART with HCV/HIV co-infection.
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