Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov-Dec;23(6):441-450.
doi: 10.1016/j.bjid.2019.10.002. Epub 2019 Nov 9.

Hepatitis B viremia in HIV-coinfected individuals under antiretroviral therapy

Leonardo Weissmann  1 , Camila de Melo Picone  2 , Michele Soares Gomes Gouvêa  3 , Paulo Roberto Abrão Ferreira  4 , Mônica Salum Valverde Borsoi Viana  5 , João Renato Rebello Pinho  6 , Alex Jones Flores Cassenote  7 , Aluísio Cotrim Segurado  8
Affiliations

Hepatitis B viremia in HIV-coinfected individuals under antiretroviral therapy

Leonardo Weissmann et al. Braz J Infect Dis. 2019 Nov-Dec.

Abstract

Background: Antiretroviral therapy (ART) has decreased AIDS incidence and mortality, rendering comorbidities, such as hepatitis B more relevant for people living with human immunodeficiency virus (HIV). Since antiretroviral drugs may also inhibit hepatitis B virus (HBV) replication, analyzing the impact of ART on management of hepatitis B in this population is important.

Objective: To assess HBV viremia among HIV/HBV coinfected individuals on ART and its associated factors.

Method: For this cross-sectional study, HIV/HBV-coinfected individuals, aged over 18 years, who were on ART for over six months and receiving care at an outpatient clinic in São Paulo were recruited. Sociodemographic characteristics, information about viral exposure, clinical and laboratory data, including evaluation of liver fibrosis were obtained. Plasma HBV DNA was measured by polymerase chain reaction. Viral genome sequencing was conducted for genotyping and identification of drug resistance-conferring mutations if viral load exceeded 900 IU/mL.

Results: Out of 2,946 patients who attended the clinic in 2015, 83 were eligible and 56 evaluated. Plasma HBV DNA was detected in 16 (28.6%) (95% CI: 18.0-41.3%), all on lamivudine and tenofovir treatment. HBV DNA detection was associated with lower education (p = 0.015), higher international normalized ratios (p = 0.045), history of an AIDS-defining illness [OR: 3.43 (95% CI: 1.10-11.50)], and HBeAg detection [OR: 6.60 (95% CI: 1.84-23.6)]. In contrast, a last CD4+ count above 500 cells/mm3 in the year prior to inclusion [OR: 0.18 (95% CI: 0.04-0.71)] and detection of anti-HBe [OR: 0.21 (95% CI: 0.04-0.99)] were negatively associated. Patients with HBV DNA above 900 IU/mL were infected with subgenotypes A1 (n = 3) and D2 (n = 1), and exhibited viral mutations associated with total resistance to lamivudine and partial resistance to entecavir.

Conclusions: Despite being on ART, a significant proportion of HIV/HBV-coinfected individuals present HBV viremia. Characterization of factors that are associated with this finding may help professionals provide better management to these patients.

Keywords: Antiretroviral agents; Coinfection; DNA, viral; HIV infections; Hepatitis B; Viremia.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Time using anti-HBV medication (in years) by HBV viremic and nonviremic patients (1A - lamivudine; 1B - tenofovir).
See this image and copyright information in PMC

References

    1. Trépo C., Chan H., Lok A. Hepatitis B virus infection. Lancet. 2014;384:2053–2063. https://www.ncbi.nlm.nih.gov/pubmed/24954675 - PubMed
    1. World Health Organization Geneva; 2017. Global hepatitis report 2017. https://apps.who.int/iris/handle/10665/255016
    1. Sun H.Y., Sheng W.H., Tsai M.S., Lee K.Y., Chang S.Y., Hung C.C. Hepatitis B virus coinfection in human immunodeficiency virus-infected patients: a review. World J Gastroenterol. 2014;20:14598–14614. https://www.ncbi.nlm.nih.gov/pubmed/25356024 - PMC - PubMed
    1. Konopnicki D., Mocroft A., de Wit S., et al. Hepatitis B and HIV: prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort. AIDS. 2005;19:593–601. https://www.ncbi.nlm.nih.gov/pubmed/15802978 - PubMed
    1. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais (DIAHV). Boletim Epidemiológico 2018 – Hepatites Virais. Ano VI – nº 01. http://portalarquivos2.saude.gov.br/images/pdf/2018/julho/05/Boletim-Hep....

MeSH terms