HIV Outcomes in Hepatitis B Virus Coinfected Individuals on HAART

Abstract

Background Understanding the impact of hepatitis B virus (HBV) coinfection on HIV outcomes in the HAART era continues to be a critical priority given the high prevalence of coinfection and the potential for impaired immunologic, virologic and clinical recovery. Methods Participants from the U.S. Military HIV Natural History Study with an HIV diagnosis, on HAART and serologically confirmed HBV infection status at HAART initiation (HI) were classified into four HBV infection (HB) groups. HIV virologic, immunologic, and clinical outcomes were evaluated by HB status. Results Of 2536 HIV positive HAART recipients, with HBV testing results available to determine HB status in the HI window, HB status at HI was classified as HB negative (n=1505; 66%), resolved HB (n=518; 23%); isolated HBcAb (n=139; 6%) or; chronic HB (n=131; 6%). HIV virologic suppression and failure at 6 months or 1 year were not significantly different by HB status. A significantly faster rate of increase in CD4 cell count during the period between 4 and 12 years was observed for chronic HB relative to HB negative. Chronic and resolved HB were associated with an increased risk of AIDS/death compared to HB negative individuals (chronic HB; HR=1.68; 95% CI 1.05–2.68, resolved HB; HR=1.61; 95% CI 1.15–2.25). Conclusions HB status did not have a significant impact on HIV virologic outcomes, however, CD4 cell count reconstitution post HI and the risk of an AIDS event or death post HI may be associated with HB status.

HBV and HIV co-infection: Impact on liver pathobiology and therapeutic approaches

“…Moreover, in co-infected patients, exertion of gp 120 on elevations and intracellular accumulation of HBV, DNA as well as HBsAg is proposed (Figure 1) to cause hepatotoxicity. In a clinical study, association of HBV and HIV co-infection with higher levels of HBV DNA has suggested that factors other than a direct virusvirus interaction might contribute to the increased HBV DNA levels [9] . While it has been shown that the HBV-X protein acts in alliance with HIV-tat in facilitating HIV replication [44] , the synergistic effect of tat, if any, on HBV life cycle is not known.…”

“…Furthermore, in co-infection cases, HIV severely alters the natural history of hepatitis B [3,24] . HIV co-infection significantly decreases the rate of hepatitis B e antigen (HBeAg) clearance up to five-fold and increases the level of HBV replication [9,25] . Even co-infected persons who seroconvert to protective antibody to hepatitis B surface antigen (HBsAg) [anti-hepatitis B surface antibody (HBsAb)], remain at risk of reverse-seroconversion, and subsequent reactivation of HBV [26,27] .…”

“…It is found that in HIV co-infected individuals, liver-related mortality is over 17 times higher than those infected with HBV, alone [2] . Also, with the introduction of "highly active anti-retroviral therapy (HAART)" in high HBV endemic areas, greater chances of progressive liver diseases is expected in the HIV co-infected individuals [9] . Moreover, HIV co-infection severely alters the natural history of hepatitis B [9] .…”

“…Also, with the introduction of "highly active anti-retroviral therapy (HAART)" in high HBV endemic areas, greater chances of progressive liver diseases is expected in the HIV co-infected individuals [9] . Moreover, HIV co-infection severely alters the natural history of hepatitis B [9] . As a result, management of chronic hepatitis B is hampered by the late and/or improper diagnosis as well as by effectiveness of nucleos(t)idebased anti-viral therapy, and risks of emergence of drugresistance.…”

Liver fibrosis after antiretroviral therapy in a longitudinal cohort of sexually infected HIV patients in eastern China

“…HIV infection adversely impacts on the progression of liver diseases. For example, HIV/hepatitis B virus (HBV) co-infected patients had significantly decreased rate of hepatitis B surface antigen (HBsAg) clearance and increased HBV replication than HBV monoinfected individuals (2)(3), and HIV/hepatitis C virus (HCV) coinfected patients had lower rate of HCV viral suppression than HCV monoinfected controls (4). Consequently, progression to cirrhosis is more rapid in HIV-infected patients with chronic liver diseases (5)(6).…”