HBV‐DNA levels predict overall mortality in HIV/HBV coinfected individuals

Abstract

The coinfection of Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) has been associated with increased death rates. However, the relevant research has mostly relied on serologic HBV testing [HBV surface antigen (HBsAg)]. The aim of this work was to explore the relationship of HBV viraemia with overall mortality among HIV/HBV coinfected individuals. The analysis included 1,609 HIV seropositives of a previously described cohort (1984-2003) with limited exposure to tenofovir (12%) and a median follow-up of approximately 5 years. Those with persistent expression of HBsAg were further tested for HBV-DNA. The data were analyzed using Poisson regression models. Totally, 101 participants were chronic carriers of HBsAg (6.28%). Of these, 81 were tested for HBV-DNA. The median HBV-DNA levels were 3.81 log (base-10) International Units (IU)/ml. A third (31%) of those tested for HBV-DNA had received tenofovir. Before developing acquired immune deficiency syndrome (AIDS), the adjusted incidence rate ratio (IRR) for all-cause mortality of coinfected patients with HBV viraemia above the median value versus the HIV monoinfected group was 3.44 [95% confidence interval (CI): 1.05-11.27]. Multivariable regressions in the coinfected group only (n = 81) showed that one log-10 increase in HBV-DNA levels was associated with an elevated risk for death (IRR: 1.24, 95%CI: 1.03-1.49). HBV-DNA levels predict overall mortality in the setting of HIV/HBV coinfection, especially during the period before developing AIDS, and could thus help prioritize needs and determine the frequency of medical monitoring.

Proportion and factors associated with Hepatitis B viremia in antiretroviral treatment naïve and experienced HIV co-infected Ghanaian patients

“…Routine Hepatitis B screening is essential in the evaluation and management of HIV patients. Elevated HBV DNA level is associated with overall mortality in HBV/HIV co-infected patients, especially during the period before development of AIDS [ 30 ], and it is essential to identify patients who have viremia for treatment intensification. Majority of ART-naïve (89 %) and 42 % of ART-experienced patients were found to have detectable HBV.…”

Hepatitis B and HIV coinfection in Northern Uganda: Is a decline in HBV prevalence on the horizon?

“…Secondly, our sampling procedures were performed in the AIDS clinic, and our study population consisted of regularly attending outpatients in good clinical condition with a high rate of adherence to ART (87.3%), which they had been receiving for a median of six years. Other studies of PLWH outpatients have reported comparable prevalence rates ranging from 6.7% to 11.5% [25,26,35] and, assuming that HIV/HBV co-infected patients experience a faster clinical evolution than other PLWH, it is possible that a disproportional number of coinfected patients were not enrolled [14,27,29]. Third, it cannot be excluded that mortality among the co-infected may have been higher than in the PLWH population as a whole, thus leading to a lower prevalence of HBV among the survivors.…”

“…whole Northern Uganda [6]. However, coinfection prevalence was similar to the prevalence of HBV co-infection in Europe [18,[27][28][29], North America [12,30], and even in sub-Saharan Africa [31], where the reported ranges are wider than in Western countries and can reach 36% [5]. In countries where HBV is highly endemic, most cases of infection are attributable to vertical or horizontal transmission during early childhood [23,[32][33][34], although the findings of a recent study challenge the predominant role of vertical transmission in the area of Gulu [35].…”

The evaluation of antiretroviral treatment in HIV and hepatitis B virus (HBV) co-infected persons in Beijing, China, 2010-2018: a retrospective cohort study

“…Incidence of hepatic fibrosis (14.2%) and cirrhosis (9.2%) is more likely to occur in HIV/HBV co-infection patients [28][29][30][31] and the liver-related mortality in these patients was 8 times higher than that in HIV monoinfection patients [2,32]. Besides, HIV/HBV coinfection is a risk factor for in-hospital mortality [33], which also heightened overall mortality rates (Incidence Rate Ratio: 1.24) [34][35][36][37].…”