Coinfection With Hepatitis Viruses and Outcome of Initial Antiretroviral Regimens in Previously Naive HIV-Infected Subjects

Luca, Andrea De; Bugarini, Roberto; Lepri, Alessandro Cozzi; Puoti, Massimo; Girardi, Enrico; Antinori, Andrea; Poggio, A; Pagano, Gabriella; Tositti, Giulia; Cadeo, GianPiero; Macor, Antonio; Toti, M; Monforte, Antonella d’Arminio

doi:10.1001/archinte.162.18.2125

Cited by 218 publications

(181 citation statements)

References 36 publications

Supporting

Mentioning

147

Contrasting

Unclassified

Order By: Relevance

“…In our collaborative study, information on drug use after HIV infection or treatment adherence is not collected for the majority of individual cohorts. Other factors especially prevalent in injecting drug users and associated with a poor immunological response, such as hepatitis C virus coinfection [31] or tobacco smoking [32,33], might also explain their poorer responses. Specific epidemiological surveys that appropriately measure these variables would be of value to disentangle the respective roles of different factors explaining poor response in injecting drug users.…”

mentioning

confidence: 99%

Determinants of response to first HAART regimen in antiretroviral‐naïve patients with an estimated time since HIV seroconversion

et al. 2005

View full text Add to dashboard Cite

ObjectiveTo study the determinants of immunological and virological response to highly active antiretroviral therapy (HAART) in naïve patients, adjusting for time since HIV-1 seroconversion. DesignData from HIV-cohort studies where dates of seroconversion have been reliably estimated. MethodsIn previously untreated patients, short-and long-term marker responses from HAART initiation (three or more antiretroviral drugs) to the end of follow-up or any treatment modification were considered using mixed effects models accounting for undetectable HIV viral load and informative dropout. ResultsIn total, 943 patients were treated with a first HAART regimen for a median of 29 months. In adjusted analyses, compared with a reference group of homosexual men without AIDS initiating treatment 4 years after seroconversion, injecting drug users (IDUs) were treated at similar CD4 and HIV RNA levels but had poorer short-term virological response (2.54 vs 2.13 log 10 HIV-1 RNA copies/mL at 1.5 months, P 5 0.03) and poorer long-term immunological response (522 vs 631 cells/ mL at 24 months, Po0.0001). Although individuals with AIDS at HAART initiation had lower CD4 counts (206 vs 382 cells/mL, Po0.0001), their immunological responses were similar to those of individuals without AIDS. Similarly, individuals further from seroconversion started HAART at lower CD4 counts (e.g. 311 vs 382 cells/mL at vs before 9 years from seroconversion, Po0.0001), but had similar CD4 responses. However, they experienced poorer long-term virological response (0.67 log 10 copies/mL/year smaller decline, Po0.0001) compared to those treated before 9 years from seroconversion. ConclusionTaking into account the time elapsed since seroconversion, this study suggests that careful choices of initial treatment should be made and intensive follow-up carried out in high-risk subgroups such as IDUs who have poorer responses.Keywords: CD4 T lymphocytes, HIV infection, HIV RNA, longitudinal study, seroconverters IntroductionThe clinical management of patients infected with HIV is mainly based on two markers -the CD4 T lymphocyte count and the plasma HIV RNA viral load -because of their [8,[10][11][12] or poorer [13,14] immunological response. One possible hypothesis to explain these discrepancies could be that time since seroconversion may influence individual response to antiretroviral treatment and may vary across the categories studied, therefore acting as a confounding factor. In this study, we used data on HIV seroconverters from a large international collaboration to determine whether time elapsed since HIV seroconversion has an independent effect on immunological and virological response to first HAART regimen. Further, we asked whether adjusting for time since seroconversion alters the association of other factors with response to therapy. Methods Study populationCASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) is a collaboration of groups representing 22 cohorts in Europe, Australia and Canada in which the date of HIV-1 seroconver...

show abstract

mentioning

confidence: 99%

Determinants of response to first HAART regimen in antiretroviral‐naïve patients with an estimated time since HIV seroconversion

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Several studies have shown that chronic HBV infection significantly increased liver-related mortality in HIV-1-infected patients but did not have a direct impact on progression to AIDS or on viral and immunological responses to ART. [24][25][26] However, studies from Taiwan found that individuals with chronic hepatitis B were less likely to achieve HIV RNA suppression at 4 and 24 months after initiation of ART. 26,27 Overall, it is still debated whether HBV co-infection might negatively affect the efficacy of antiretroviral therapy.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes in a cohort of patients with chronic hepatitis B and human immunodeficiency virus co-infection in Mumbai, India

Isaakidis¹,

Mansoor²,

Zachariah³

et al. 2012

International Health

View full text Add to dashboard Cite

CitationTreatment outcomes in a cohort of patients with chronic hepatitis B and human immunodeficiency virus coinfection in Mumbai, India 2012, 4 (4) Treatment experiences with patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in resource-limited settings remain poorly documented.This study aimed to evaluate the treatment outcomes in a cohort of HIV/HBV co-infected individuals receiving tenofovir/lamivudine (TDF/3TC)-based antiretroviral therapy (ART) in a programmatic setting in Mumbai, India. Additionally, a cross-sectional laboratory study was carried out measuring serologic and virologic parameters. A total of 57 patients who received TDF/3TC were included in the study. Of these, 52 (91%) were male and the mean age was 38.7 years. The median follow-up period was 16.8 months (IQR:7.9-37.9). Forty-three patients were included in the cross-sectional laboratory study, of whom 38 (67%) were HBeAg + positive. Four patients had serum HBsAg conversion to negative and had developed anti-HBs-antibodies. HBV-DNA became undetectable (<1.3 log 10 copies/ml or <20 IU/ml) in 35.5% and 75% of the HBeAg + and HBeAg − patients, respectively. Overall, 46.5% of patients had undetectable HBV-DNA and 90.7% had adequately suppressed HBV-DNA (<3.3 log 10 copies/ml or <2000 IU/ml). The median reduction in serum HBV-DNA was 6 log 10 copies/ml. In 29 patients (63%) HIV viral load was undetectable. Outcomes included seven (12%) deaths, four (7%) lost to follow-up, one (2%) transferred out and 45 (79%) alive and on treatment. In conclusion, good treatment outcomes were achieved in a cohort of HIV/HBV co-infected patients in India. In regions with a high HIV/HBV burden, all HIV-infected individuals should be tested for chronic hepatitis B. A TDF/3TC-backbone could be considered as first-line standardized ART regimen in these settings.

show abstract

“…A cohort study in Italy has showed increasing divergence of mean CD4 lymphocyte counts up to 36 weeks after HAART initiation between patients with and without chronic hepatitis B as compared to those with chronic hepatitis B having a lesser CD4 increase (P = 0.03) [13]. In a cohort study in Denmark HBV infection sero-status is observed to have no effect on the response to HAART in terms of HIV viral load suppression and CD4 + cell count [3].…”

Section: Hepatitis B Virus Co-infection: Yet Another Reason For Earlymentioning

confidence: 97%

Hepatitis B Virus Co-Infection: Yet Another Reason for Early Initiation of Treatment in HIV Infected Individuals

Hailaye¹,

Dessalegn²,

Gebre-Selassie³

2013

WJA

View full text Add to dashboard Cite

Background: Hepatitis B virus (HBV) co-infection with HIV is becoming a major challenge due to shared routes of transmission. The burden is apparent in regions with widespread use of antiretroviral treatment, which led to the enhanced emergence of liver-related diseases and mortality. Though there are conflicting results about the effect of chronic HBV infection on response to highly active antiretroviral therapy (HAART) (CD4 + cell count and HIV viral load, HIV RNA copies/ml), HAART is known to cause immune mediated HBV specific liver damage after it reconstitutes cell-mediated immunity. The relationship of different HAART regimes with immune recovery is an area of research interest. Objective: It is in order to determine the changes in immune recovery during HBV infection in the setting of HAART among HIV positive individuals attending care and treatment services. Methods: Two cohorts of co-infected patients were analyzed from data of one to seven months retrospectively. The first group (n = 380) was antiretroviral drug naive and the second cohort (n = 380) was on HAART for the entire period. The study was conducted in one referral hospital and six health centers. Data were gathered from 760 patients using their intake form, their follow-up form and their medical records supplemented by data from a structured questionnaire. HBV infection was determined by using HBsAg rapid and confirmatory tests and CD4 cells were enumerated by using laboratory registers and patient cards. Bivariate and multivariate logistic regressions were done by using SPSS Version 18 and Epi info Version 3.5. Results: Poor immune recovery due to HBV infection was improved after initiation of HAART. Before the initiation of HAART, the mean CD4 cell count of HBV infected individuals was lower than that of non-HBV infected ones, 234/mm 3 and 384/mm 3 , respectively (p < 0.05). Individuals co-infected with HBV had experienced delayed recovery of immune cells (CD4 cell count). However, after, on average, more than two years of therapy, the association is reversed. In addition to HBV infection, CD4 cell count of patients on chronic HIV care/pre-ART was decreased by older age, living in rural areas and previous opportunistic infections. Conclusion: HBV infection has different outcomes between pre-ART and ART-initiated individuals. In the former cohort, HBV infection causes significant delays in immune recovery which is reversed after initiation of anti-HIV treatment. HBV co-infection has a significant and immediate negative effect on CD4 cell counts and immune recovery before HAART but such effects slowly subside after initiation of the treatment. As a result, HBV infection is another issue to consider for swift initiating of HAART for HIV infected individuals in long-term care.

show abstract

Coinfection With Hepatitis Viruses and Outcome of Initial Antiretroviral Regimens in Previously Naive HIV-Infected Subjects

Cited by 218 publications

References 36 publications

Determinants of response to first HAART regimen in antiretroviral‐naïve patients with an estimated time since HIV seroconversion

Determinants of response to first HAART regimen in antiretroviral‐naïve patients with an estimated time since HIV seroconversion

Treatment outcomes in a cohort of patients with chronic hepatitis B and human immunodeficiency virus co-infection in Mumbai, India

Hepatitis B Virus Co-Infection: Yet Another Reason for Early Initiation of Treatment in HIV Infected Individuals

Contact Info

Product

Resources

About