Response to ART in HIV/HBV Coinfected Patients
Response to ART in HIV/HBV Coinfected Patients
Objective: To evaluate the influence of hepatitis B virus (HBV) coinfection on immunological, virological and clinical responses to lamivudine (3TC)-based combined antiretroviral therapy (cART) in Chinese patients.
Design and methods: This prospective, multicenter cohort study recruited 529 antiretroviral-naive participants (aged 18–65 years, both sexes) between 2008 and 2010. They were grouped by HBV serostatus. Virological and immunological responses were monitored at baseline and week 4, 8, 12, 24, 36 and 48. cART for all patients was nevirapine, 3TC with either zidovudine or stavudine.
Results: First, HIV/HBV coinfection rate in our cohort was 14.6%. Second, among 508 patients with complete baseline information, median CD4 level was significantly lower in the chronic HBV-infected (CHB) group and isolated core group. In the CHB group, hepatitis B e antigen positivity rather than HBV DNA level was associated with lower CD4 cell count. Third, in the isolated core group, occult infection rate was 9.5%. Fourth, at week 48, rate of HIV suppression below 40 copies/ml was 74.2%. Median increase in the CD4 cell count at week 48 was 127 cells/μl. Of note, HBV serostatus did not influence virological and immunological response to cART at each follow-up time point. Although HBV serostatus was associated with different alanine aminotransferase levels during follow-up, hepatitis and hyperbilirubinemia rates were not significantly different. Fifth, the 3TC-based regimen was efficacious against HBV replication, with median decrease in HBV DNA of 2.87 log copies/ml. However, hepatitis B e antigen positivity was associated with poorer HBV DNA suppression.
Conclusion: In our cohort, CHB infection and isolated hepatitis B core antibody positivity were related to faster HIV progression. Despite of this, virological and immunological responses were not affected by HBV serostatus.
Ever since the introduction of combined antiretroviral therapy (cART), morbidities and mortalities in the HIV-infected population have been shifted in which viral hepatitis plays a crucial role. Among HIV-infected populations from developed countries, prevalence of HIV/hepatitis B virus (HBV) coinfection is 6–14% [3]. Unfortunately, in developing countries where HBV is endemic, HIV/HBV coinfection is still poorly understood. In China, approximately 760 000 people are living with HIV/AIDS [4]; meanwhile, China is still suffering from high HBV endemicity, albeit a national immunization program has dramatically lowered hepatitis B surface antigen (HBsAg) prevalence in children (weighted population prevalence 7.2%). To our knowledge, there has been no prospective, multicenter research to address this issue in China.
HIV coinfection exacerbates HBV-related liver disease, which has been extensively studied (reviewed in). Apart from those reviewed by Thio, HIV coinfection could also be associated with higher rate of occult HBV infection, which is defined as an absence of HBsAg in the blood but presence of HBV DNA in liver tissue or plasma. Recent studies also suggest that low CD4 cell count in HIV infection is associated with high occult HBV infection rate, although this contention is still in dispute. On the contrary, how HBV infection influence HIV infection remains largely unknown. Previous studies suggested that HBV did not lead to faster HIV progression to AIDS. In addition, a cohort study from Taiwan indicated that coinfection with HBV may lead to HIV virological failure in the setting of high HBV endemicity and advanced immunosuppression.
Lamivudine (3TC) with its dual efficacy against both HIV and HBV is still the first-line regimen in some developing countries, including China. However, long-term use of 3TC in the HIV/HBV-coinfected group may lead to a higher HBV mutation rate. To date, no prospective, large-scale clinical research has been conducted in China to illustrate the efficacy of 3TC-based regimen in HIV/HBV-coinfected patients.
In this study, we wanted to address how HBV infection influences HIV infection both at baseline level and during 48-week treatment.
Abstract and Introduction
Abstract
Objective: To evaluate the influence of hepatitis B virus (HBV) coinfection on immunological, virological and clinical responses to lamivudine (3TC)-based combined antiretroviral therapy (cART) in Chinese patients.
Design and methods: This prospective, multicenter cohort study recruited 529 antiretroviral-naive participants (aged 18–65 years, both sexes) between 2008 and 2010. They were grouped by HBV serostatus. Virological and immunological responses were monitored at baseline and week 4, 8, 12, 24, 36 and 48. cART for all patients was nevirapine, 3TC with either zidovudine or stavudine.
Results: First, HIV/HBV coinfection rate in our cohort was 14.6%. Second, among 508 patients with complete baseline information, median CD4 level was significantly lower in the chronic HBV-infected (CHB) group and isolated core group. In the CHB group, hepatitis B e antigen positivity rather than HBV DNA level was associated with lower CD4 cell count. Third, in the isolated core group, occult infection rate was 9.5%. Fourth, at week 48, rate of HIV suppression below 40 copies/ml was 74.2%. Median increase in the CD4 cell count at week 48 was 127 cells/μl. Of note, HBV serostatus did not influence virological and immunological response to cART at each follow-up time point. Although HBV serostatus was associated with different alanine aminotransferase levels during follow-up, hepatitis and hyperbilirubinemia rates were not significantly different. Fifth, the 3TC-based regimen was efficacious against HBV replication, with median decrease in HBV DNA of 2.87 log copies/ml. However, hepatitis B e antigen positivity was associated with poorer HBV DNA suppression.
Conclusion: In our cohort, CHB infection and isolated hepatitis B core antibody positivity were related to faster HIV progression. Despite of this, virological and immunological responses were not affected by HBV serostatus.
Introduction
Ever since the introduction of combined antiretroviral therapy (cART), morbidities and mortalities in the HIV-infected population have been shifted in which viral hepatitis plays a crucial role. Among HIV-infected populations from developed countries, prevalence of HIV/hepatitis B virus (HBV) coinfection is 6–14% [3]. Unfortunately, in developing countries where HBV is endemic, HIV/HBV coinfection is still poorly understood. In China, approximately 760 000 people are living with HIV/AIDS [4]; meanwhile, China is still suffering from high HBV endemicity, albeit a national immunization program has dramatically lowered hepatitis B surface antigen (HBsAg) prevalence in children (weighted population prevalence 7.2%). To our knowledge, there has been no prospective, multicenter research to address this issue in China.
HIV coinfection exacerbates HBV-related liver disease, which has been extensively studied (reviewed in). Apart from those reviewed by Thio, HIV coinfection could also be associated with higher rate of occult HBV infection, which is defined as an absence of HBsAg in the blood but presence of HBV DNA in liver tissue or plasma. Recent studies also suggest that low CD4 cell count in HIV infection is associated with high occult HBV infection rate, although this contention is still in dispute. On the contrary, how HBV infection influence HIV infection remains largely unknown. Previous studies suggested that HBV did not lead to faster HIV progression to AIDS. In addition, a cohort study from Taiwan indicated that coinfection with HBV may lead to HIV virological failure in the setting of high HBV endemicity and advanced immunosuppression.
Lamivudine (3TC) with its dual efficacy against both HIV and HBV is still the first-line regimen in some developing countries, including China. However, long-term use of 3TC in the HIV/HBV-coinfected group may lead to a higher HBV mutation rate. To date, no prospective, large-scale clinical research has been conducted in China to illustrate the efficacy of 3TC-based regimen in HIV/HBV-coinfected patients.
In this study, we wanted to address how HBV infection influences HIV infection both at baseline level and during 48-week treatment.
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