Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort

Abstract

Objectives: Prompted by international targets for elimination of hepatitis B virus (HBV), we set out to characterise individuals with HBV monoinfection vs. those coinfected with HBV/HIV, to evaluate the impact of therapy and to guide improvements in clinical care. Methods: We report observational data from a real world cross-sectional cohort of 115 adults with chronic hepatitis B infection (CHB), at a university hospital in Cape Town, South Africa. HIV coinfection was present in 39 (34%) subjects. We recorded cross-sectional demographic, clinical and laboratory data. Results: Compared to those with HIV coinfection, HBV monoinfected adults were less likely to be HBeAgpositive (p = 0.01), less likely to have had assessment with elastography (p < 0.0 0 01), and less likely to be on antiviral treatment (p < 0.0 0 01); they were more likely to have detectable HBV viraemia (p = 0.04), and more likely to have features of liver disease including moderate/severe thrombocytopaenia (p = 0.007), elevated bilirubin (p = 0.004), and elevated APRI score (p = 0.02). Three cases of hepatocellular carcinoma all arose in HBV monoinfection. Conclusions: Our data demonstrate that individuals with HBV monoinfection may be disadvantaged compared to those with HIV coinfection, highlighting potential systematic inequities in referral, monitoring and treatment.

The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda

“…According to current guidelines, only 25–35% of adults with CHB are eligible for treatment, leaving the majority at risk of both longer term complications (relevant to the individual) and the potential for transmission (relevant to populations) ( McNaughton et al, 2021 ). HBV/HIV co-infected individuals may have a treatment advantage, reflecting the benefits of greater access to early and consistent antiviral treatment compared to mono-infected individuals ( Maponga et al, 2020 ). Potential risks should be considered: toxicity and side effects, requirement for monitoring, potential for drug resistance, limited gains from treating well people and the cost of drug and potential diversion of healthcare resources ( McNaughton et al, 2021 ).…”

Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa

“…Two cohorts had specific criteria that could reduce applicability: one restricted to asymptomatic patients with HBV DNA > 3.2 log10 IU/ml 16 , and another excluded patients with body mass index (BMI) > 28 kg/m 2 23 . Three studies performed TE in a subset of the overall cohort with non-random selection: two due to equipment availability 15 , 36 , and one at clinician’s discretion without specifying criteria 30 . Two studies had significant loss to follow-up between community diagnosis and evaluation at clinic 37 , 38 .…”

Barriers that prevent adults living with HBV infection from participating in clinical research: experience from South Africa

“…HBV research being undertaken in these communities has been described in previous papers, which provide a backdrop and context to our experience. 8,9 We here present our perspectives to support the development of an improved evidence-base for interventions and resources that drive enhanced representation and engagement, and to inform future research enterprise. By enhancing awareness, sharing experience, and promoting dialogue, barriers to participation in research and access to clinical care can be tackled.…”

“…The studies that formed the backdrop for this perspective are approved by Oxford Tropical Research Ethics Committee (ref. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], Stellenbosch University (ref. N17/01/013) and The University of the Free State (UFS-HSD2018/0193-0001).…”