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

Abstract

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.

Seasonal variation of hepatitis B and C virus infection among HIV- and non-HIV-infected patients in Benin City, Nigeria

“…Reports indicate that HIV-positive patients infected with HCV and/ or HBV have increased risk of liver disease worldwide [6]. An increase in the rate of progression of HIV infection to AIDS has been reported among HIV-positive patients with HBV and/or HCV infection [7][8][9][10].…”

Comparison of HBV-active HAART regimens in an HIV–HBV multinational cohort

“…[9–12] Thus, the long-term efficacy of lamivudine-based ART in resource-limited settings may be different than in resource-rich settings. A Thai study of 11 HBeAg-negative and 19 HBeAg-positive HIV-HBV co-infected subjects taking lamivudine-based ART for up to 5 years found that all the HBeAg-negative subjects maintained suppression (HBV DNA <150 IU/ml) and none developed lamivudine-resistant HBV.…”

Mutations in the Basal Core Promoter and Precore/Core Regions of Hepatitis B Virus in Patients Co-Infected With Human Immunodeficiency Virus

“…Although CP mutations may enhance HBV replication (28), several clinical reports have revealed that the presence of 1762T/1764A mutation is not always associated with the high HBV-DNA levels (29). In the study of Chilo L. et al, CD4 counts of patients with HIV/HBV infection were significantly lower than mono-infected patients (30). Another study also demonstrated low amount of CD4 cells in co-infected patients (31).…”