Hepatitis B Co-Infection is Associated with Poorer Survival of HIV-Infected Patients on Highly Active Antiretroviral Therapy in West Africa

Abstract

Background Hepatitis B has been reported to be high in HIV-infected African populations. However, the impact of this co-infection on the survival of HIV-infected Africans on long-term highly active antiretroviral therapy (HAART) remains poorly characterised. We investigated the impact of HBV/HIV co-infection on survival of HIV infected patients undergoing antiretroviral therapy in a West African population. Methods This was a clinic-based cohort study of HIV-infected adults enrolled in Nigeria, West Africa. Study subjects (9,758) were screened for hepatitis B and hepatitis C at HAART initiation. Kaplan-Meier survival and Cox proportional hazards models were used to estimate probability of survival and to identify predictors of mortality respectively, based on hepatitis B surface antigen status. All patients had signed an informed written consent before enrolment into the study; and we additionally obtained permission for secondary use of data from the Harvard institutional review board. Results Patients were followed up for a median of 41 months (interquartile range: 30–62 months) during which, 181 (1.9%) patients died. Most of the deaths; 143 (79.0%) occurred prior to availability of Tenofovir. Among those that were on antiretroviral therapy, hepatitis B co-infected patients experienced a significantly lower survival than HIV mono-infected patients at 74 months of follow up (94% vs. 97%; p=0.0097). Generally, hepatitis B co-infection: HBsAg-positive/HIV-positive (Hazards Rate [HR]; 1.5: 95% CI 1.09–2.11), co-morbid tuberculosis (HR; 2.2: 95% CI 1.57–2.96) and male gender (HR; 1.5: 95% CI 1.08–2.00) were significantly predictive of mortality. Categorising the patients based on use of Tenofovir, HBV infection failed to become a predictor of mortality among those on Tenofovir-containing HAART. Conclusions HBsAg-positive status was associated with reduced survival and was an independent predictor of mortality in this African HIV cohort on HAART. However, Tenofovir annulled the impact of HBV on mortality of HIV patients in the present study cohort.

Chronic hepatitis B increases mortality and complexity among HIV‐coinfected patients in South Africa: a cohort study

“…CHB has been reported to increase mortality among HIV‐coinfected populations in Europe and North America. However, there is uncertainty regarding the mortality effect of CHB among patients on ART in Africa . Our finding of increased mortality with CHB is consistent with some prior studies from low‐ and middle‐income countries (LMICs) .…”

“…However, there is uncertainty regarding the mortality effect of CHB among patients on ART in Africa [14][15][16][17]. Our finding of increased mortality with CHB is consistent with some prior studies from low-and middle-income countries (LMICs) [14,15,17]. Notably, our study provides additional insight because we were able to stratify by HBV DNA level.…”

Impacts of hepatitis B and hepatitis C co-infection with tuberculosis, a prospective cohort study

“…Hepatitis B or hepatitis C co-infection with tuberculosis increase the risk of treatment failure [19] activates latent tuberculosis [20][21][22], increase the risk of mortality [23], and drug-induced liver injury [24][25][26][27][28].…”

Reasons why West Africa continues to be a hotbed for hepatocellular carcinoma

“… 13 A recent large study in Nigeria demonstrated that HBV co-infection is associated with a significant decrease in survival, compared to HBV-negative HIV-infected individuals, a trend that can be counteracted through the use of tenofovir-containing HAART. 14 The larger sample size involved favours this study over the conflicting evidence found in previous smaller studies in the developing world, with both positive and negative findings acquired. 13 However, more investigation into the link between HIV, viral hepatitis and HCC is required.…”