Hepatitis B Virus Infection and Response to Antiretroviral Therapy (ART) in a South African ART Program

Abstract

Background Coinfection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common in Africa; however, the impact of HBV infection on the outcomes of antiretroviral therapy programs is unclear. We evaluated the impact of chronic hepatitis B on HIV virologic response, changes in CD4 cell count, hepatotoxicity, and mortality among Africans receiving highly active antiretroviral therapy (HAART). Methods We conducted a retrospective cohort study involving a workplace HAART program in South Africa. Participants received HAART according to a protocol and were followed up for up to 72 weeks. On the basis of pre-HAART serum assays, patients were classified as being hepatitis B surface antigen (HBsAg) negative, HBsAg positive with a low HBV DNA level (≤1 × 104 copies/mL), and HBsAg positive with a high HBV DNA level (>1 × 104 copies/mL). The relationships between HBV status and HIV RNA suppression, change in CD4 cell count, mortality, and hepatotoxicity were assessed with use of regression techniques. Results Five hundred thirty-seven individuals fulfilled the inclusion criteria; 431 (80.3%) of these patients were HBsAg negative, 60 (11.2%) were HBsAg positive with a low HBV DNA level, and 46 (8.6%) were HBsAg positive with a high HBV DNA level. All groups had similar rates of HIV RNA suppression (P =.61), CD4 cell count increases (P =.75), and mortality (17 total deaths; P =.11) for up to 72 weeks after the initiation of HAART. Baseline transaminase levels were highest in the group with high HBV DNA levels (P =.004). Hepatotoxicity was similar between the HBsAg-negative group and the group with low HBV DNA levels but was higher in the group with high HBV DNA levels (incidence rate ratio, 4.4). Conclusions We revealed that HBV status does not affect HIV RNA suppression, CD4 cell count response, or mortality during the first 72 weeks of HAART in an African setting. The risk of HBV-associated hepatotoxicity, however, is associated with the baseline HBV DNA level.

Hepatitis B virus in HIV-infected patients in north-eastern South Africa: Prevalence, exposure, protection and response to HAART

“…[19] Although hepatotoxicity of HAART is increased by the presence of HBV, studies have shown that patients with high HBV-DNA baseline levels have a higher risk of hepatotoxicity than non-HBV-infected HIV patients. [9] Most of the patients in the current study had undetectable and low viral loads prior to therapy initiation and within a year on HAART, which may explain why the average level of aminotransferase was not significantly higher in these patients, concurring with the observation of Boyles and Cohen [8] that aminotransferase may be an insensitive marker for HBV infection. It could be assumed that most of the patients on HAART in the studied population had a lower risk of developing hepatotoxicity within the first year of treatment.…”

“…[8,11,13] However, high prevalence rates have also been documented; for example, Hoffmann et al reported a prevalence of 20% among male mine workers in several regions of South Africa. [9] In Gauteng Province, exposure to HBV, based on HBsAg and antiHBc, of 39% was documented in HIV-infected women. [10] The current study also examined the effect of declining CD4+ cell count on the prevalence of HBV, as reactivation is expected to be proportional to the level of immune depreciation.…”

“…Hoffmann and colleagues reported a prevalence of 20% among male mine workers in several regions of South Africa. [9] In Gauteng Province, exposure to HBV, considering HBsAg and anti-HBc, of 39% was documented in HIV-positive women. [10] An earlier prospective study in Johannesburg showed a 6% infection rate of HIV/HBV co-infection.…”

HIV/HBV Co-infection - A Global Challenge

“…Further, HIV-infected patients co-infected with HBV have an increased risk for antiretroviral therapy-related hepatotoxicity, particularly when HBV DNA levels exceed 10,000 copies/ml 4 . Both can lead to chronic disease, cancer and death and neither can be eradicated with the use of current therapies.…”

Prevalence of hepatitis B e antigen among human immunodeficiency virus and hepatitis B virus co-infected patients in Jos, Nigeria

“…So far, the impact of HIV on HBV-replication has largely been unexplored in Nigeria. Furthermore, with the wide use of antiretroviral therapy (ART) for HIV-infected individuals, antiretroviral drug-induced hepatotoxicity has been more frequently reported in HIV/HBV coinfected subjects with high HBV replication [16]. This further makes determinations of HBV replication markers a priority in co-infected patients in a country such as Nigeria where access to ART is being scaled up.…”