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Multicenter Study
. 2009 Sep 10;23(14):1881-9.
doi: 10.1097/QAD.0b013e32832e463a.

Hepatitis B and long-term HIV outcomes in coinfected HAART recipients

Christopher J Hoffmann  1 , Eric C Seaberg, Stephen Young, Mallory D Witt, Kristin D'Acunto, John Phair, Chloe L Thio
Affiliations
Multicenter Study

Hepatitis B and long-term HIV outcomes in coinfected HAART recipients

Christopher J Hoffmann et al. AIDS. .

Abstract

Background: Chronic hepatitis B (CH-B) is common among HIV-infected individuals and increases liver-related mortality in the absence of HAART. The impact of CH-B on long-term HAART outcomes has not been fully characterized.

Methods: To address this question, HAART initiators enrolled in the Multicenter AIDS Cohort Study were retrospectively analyzed. Patients were classified by hepatitis B category based on serology at the time of HAART initiation. The association of CH-B with mortality, AIDS-defining illnesses, CD4 cell rise, and HIV suppression was assessed using regression analysis.

Results: Of 816 men followed for a median of 7 years on HAART, 350 were never hepatitis B virus (HBV) infected, 357 had past infection, 45 had CH-B, and 64 were only core-antibody positive. Despite HAART, AIDS-related mortality was the most common cause of death [8.3/1000 person-years (PYs)]. It was highest in those with CH-B (17/1000 PYs, 95% confidence interval 7.3, 42) and lowest among never HBV infected (2.9/1000 PYs, 95% confidence interval 1.4, 6.4). In a multivariable model, patients with CH-B had a 2.7-fold higher incidence of AIDS-related mortality compared with those never infected (P = 0.08). Non-AIDS-related mortality was also highest among those with CH-B (22/1000 PYs), primarily due to liver disease (compared to never infected, adjusted hazard ratio 4.1, P = 0.04). There was no significant difference in AIDS-defining events, HIV RNA suppression, and CD4 cell increase.

Conclusion: In HIV-infected patients receiving long-term HAART, HBV status did not influence HIV suppression or CD4 cell increase. However, mortality was highest among those with CH-B and was mostly due to liver disease despite HBV-active HAART.

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Conflict of interest statement

Conflicts of Interest: No conflicts

Figures

Figure 1
Figure 1. Median weekly CD4 change during phase 1 and phase 2 after HAART initiation for subjects with HIV RNA suppression, by HBV status
Medians with 95% confidence intervals (boxes) and upper and lower values (whiskers). CH-B, chronic hepatitis B. Mean weekly CD4 change during the first phase: never infected, 2.7 cells/mm3; past infection 1.4 cells/mm3; CH-B, 4.2 cells/mm3; isolated core, 3.5 cells/mm3. Mean weekly CD4 change during the second phase: never infected, 0.36 cells/mm3; past infection 0.39 cells/mm3; CH-B, 0.31 cells/mm3; isolated core, 0.52 cells/mm3.
Figure 2
Figure 2. Kaplan-Meier curve of non-AIDS mortality by HBV status as determined at time of HAART initiation
HBV, hepatitis B virus; CH-B, chronic hepatitis B
See this image and copyright information in PMC

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