Predictors of HBeAg status and hepatitis B viraemia in HIV-infected patients with chronic hepatitis B in the HAART era in Brazil

Abstract

BackgroundHBV-HIV co-infection is associated with an increased liver-related morbidity and mortality. However, little is known about the natural history of chronic hepatitis B in HIV-infected individuals under highly active antiretroviral therapy (HAART) receiving at least one of the two drugs that also affect HBV (TDF and LAM). Information about HBeAg status and HBV viremia in HIV/HBV co-infected patients is scarce. The objective of this study was to search for clinical and virological variables associated with HBeAg status and HBV viremia in patients of an HIV/HBV co-infected cohort.MethodsA retrospective cross-sectional study was performed, of HBsAg-positive HIV-infected patients in treatment between 1994 and 2007 in two AIDS outpatient clinics located in the São Paulo metropolitan area, Brazil. The baseline data were age, sex, CD4 T+ cell count, ALT level, HIV and HBV viral load, HBV genotype, and duration of antiretroviral use. The variables associated to HBeAg status and HBV viremia were assessed using logistic regression.ResultsA total of 86 HBsAg patients were included in the study. Of these, 48 (56%) were using combination therapy that included lamivudine (LAM) and tenofovir (TDF), 31 (36%) were using LAM monotherapy, and 7 patients had no previous use of either one. Duration of use of TDF and LAM varied from 4 to 21 and 7 to 144 months, respectively. A total of 42 (48. 9%) patients were HBeAg positive and 44 (51. 1%) were HBeAg negative. The multivariate analysis revealed that the use of TDF for longer than 12 months was associated with undetectable HBV DNA viral load (serum HBV DNA level < 60 UI/ml) (p = 0. 047). HBeAg positivity was associated with HBV DNA > 60 UI/ml (p = 0. 001) and ALT levels above normality (p = 0. 038).ConclusionProlonged use of TDF containing HAART is associated with undetectable HBV DNA viral load. HBeAg positivity is associated with HBV viremia and increased ALT levels.

Outcomes in HIV/HBV-Coinfected Patients in the Tenofovir Era Are Greatly Affected by Immune Suppression

“…Consistent with other reports, HBV suppression was achieved more often and earlier in HBeAg-negative patients compared to those with positive antigen. 12,13,15,16 It was among those HbeAg-positive patients that optimal compliance with treatment, but not HIV suppression, was identified as factor predicting HBV DNA suppression, in support of a prior report. 16 This suggests that HBV is less forgiving than HIV, requiring higher levels of adherence to treatment.…”

“…5 Tenofovir provides much more effective suppression of HBV replication without selecting resistance mutations. [6][7][8][9][10][11][12][13] However, complete suppression of HBV may take a long time or even never be achieved in patients with high levels of replication. The duration and degree of HBV suppression needed to prevent liver disease progression and liver complications in HIV-HBV coinfection have not been well established.…”

Efficacy of Lamivudine or Entecavir on Acute Exacerbation of Chronic Hepatitis B

“…HBeAg positivity is also associated with HBV viremia and increased ALT levels in HIV/HBV co-infected patients 23. Next, we compared the response to LAM or ETV in 18 or 4 HBeAg-positive patients, respectively (Table 2) .…”

“…It has been demonstrated that the levels of HBV DNA in the HBeAg-positive phase were generally higher than those in the ant-HBe-positive phase 19 , 22 . HBeAg positivity is also associated with HBV viremia and increased ALT levels in HIV/HBV co-infected patients 23 . Next, we compared the response to LAM or ETV in 18 or 4 HBeAg-positive patients, respectively (Table 2 ) .…”

Detecção plasmática do DNA viral em indivíduos com infecção crônica pelo vírus da hepatite B coinfectados pelo vírus da imunodeficiência humana e em uso de antirretrovirais: frequência e fatores associados

“…-se destacar que 60% dos pacientes com RNA do HIV detectável na última aferição de carga viral nos 180 dias prévios à inclusão no estudo, também apresentavam DNA do VHB plasmático detectável. O paciente que apresentou maior carga viral do VHB nesta casuística (49425077 UI/mL) relatou ter interrompido a terapia nos 30 dias que antecedera sua inclusão no estudo, devido a um procedimento cirúrgico após acidente automobilístico.Correa et al83 . Porém, naquele estudo, verificou-se também associação com concentrações elevadas de alanina aminotransferase (ALT), achado que não se observou no presente estudo.…”