Impact of highly active antiretroviral therapy (HAART) on the natural history of hepatitis B virus (HBV) and HIV coinfection: relationship between prolonged efficacy of HAART and HBV surface and early antigen seroconversion.

Hôtel-Dieu, Service d'Hépatologie et de Gastroentérologie, Lyon, France.
Clinical Infectious Diseases (Impact Factor: 9.42). 10/2007; 45(5):624-32. DOI: 10.1086/520752
Source: PubMed

ABSTRACT Coinfection with hepatitis B virus (HBV) in human immunodeficiency virus (HIV)-infected patients is common. However, little is known about the natural history of chronic hepatitis B in HIV-infected populations, especially the impact of highly active antiretroviral therapy (HAART) on the outcome of HBV early antigen (HBeAg) and HBV surface antigen (HBsAg) status.
The characteristics of 92 patients coinfected with HIV and HBV were retrospectively assessed before and after HAART and lamivudine treatment to determine the impact of treatment on chronic hepatitis B and factors associated with HBeAg and/or HBsAg seroconversion.
During follow-up, 82 patients received antiretroviral therapy, 79 of whom received HAART. Twenty-eight of the 76 patients who were administered lamivudine therapy developed lamivudine resistance mutations. While receiving antiretroviral therapy, 10 of 59 HBeAg-positive patients developed antibody to HBeAg, 3 of 10 cleared HBsAg, and 2 of 3 developed antibody to HBsAg. Two of 23 HBeAg-negative patients cleared HBsAg and developed antibody to HBsAg. HBeAg and/or HBsAg seroconversion combined with an undetectable HBV DNA level (i.e., an HBV response) correlated with a sustained HIV response (P=.001), shorter duration of antiretroviral therapy (P=.058), and more-severe disease, as evaluated by Centers for Disease Control and Prevention staging (for stage B vs. stage A, P=.029; for stage C vs. stage A, P=.069). For patients with elevated baseline alanine aminotransferase levels, the HBV response correlated significantly with a greater increase in CD4 cell count while receiving HAART.
In HIV-HBV-coinfected patients, HBV response correlated with a sustained HIV response to antiretroviral therapy, usually HAART including lamivudine.

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    ABSTRACT: Background Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China. Methods We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010–11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care. Findings 33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53–2·37) and HCV co-infection (1·46, 1·25–1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89–1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02–1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80–1·10) or HCV co-infection (1·10, 0·97–1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16–1·62) and HCV co-infection (1·30, 1·17–1·45), but not HBV co-infection (0·93, 0·82–1·05), than among those with HIV only. Interpretation Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression. Funding The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.
    The Lancet Infectious Diseases 10/2014; · 19.45 Impact Factor
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    ABSTRACT: Métodos: Se realizó un perfil serológico para Hepatitis B en los pacientes VIH posi-tivos, consistente en: HBs Ag, Anticore IgG. Estos exámenes se practicaron entre el mes de junio del 2007 hasta julio del 2009. Resultados: En 24 meses se realizaron exámenes para la detección de Hepatitis B en 103 pacientes VIH positivos. Hubo una prevalencia del 3,1% (tres pacientes) con Hepatitis B crónica. Cuatro pacientes falle-cieron durante el período del estudio, nin-guno positivo para infección por Hepatitis B. Se detectaron 6 pacientes con Ig G core para VHB positivo aislado, es decir con sospecha de Hepatitis B oculta, la cual se confirmó solo en un paciente con carga viral para ADN de VHB positiva (158 copias/ml). Este paciente no se hallaba usando lamivudina en el momento del examen. Conclusión: La prevalencia de Hepatitis B en nuestros pacientes corresponde a la reportada en todo el territorio nacional. La búsqueda de infección oculta por Virus de Hepatitis B en los pacientes VIH positivos asistentes a nuestra institución arrojó como resultado un solo pa-ciente con esta patología y con una baja carga viral. La estrategia para el diagnóstico la infec-ción oculta por VHB en los pacientes usando lamivudina debe ser más estudiada.
    Infectio. 03/2010; 14(1).
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    ABSTRACT: Background In patients infected with hepatitis B virus (HBV) and HIV, hepatitis B “e” antigen (qHBeAg) and hepatitis B surface antigen quantification (qHBsAg) may be used to predict short-term HBeAg- and HBsAg-loss, respectively. AimsTo determine if these quantifiable markers also provide accurate prediction of antigen loss during long-term, extensive TDF-treatment and to further establish qHBsAg-profiles associated with HBsAg-seroconversion. Methods Prospective study of 111 co-infected, antiretroviral-experienced patients undergoing a TDF-containing regimen for >12 months. HBV-DNA viral load, qHBeAg [Paul Ehrlich Institute Units (PEIU)/mL], and qHBsAg were quantified at baseline and every 6-12 months. Sensitivity (Se) and specificity (Sp) of qHBeAg criteria were calculated using a time-dependent ROC curve and qHBsAg profiles were developed using a group-based trajectory model. ResultsAfter a median 74.2 months (IQR: 33.1-94.7) of TDF-treatment, four patients had HBsAg-seroconversion. Among the 78 (70.3%) HBeAg-positive patients, cumulative proportion with HBeAg-loss was 42.0% (n=23) at month-96. Baseline qHBeAg ≤100 PEIU/mL was the only significant factor for HBeAg-loss (adjusted-HR=2.36, 95%CI: 1.02-5.46) in multivariable analysis. In terms of predicting HBeAg-loss until month-96, qHBeAg ≤10 PEIU/mL was more accurate when evaluated at month-24 (Se=0.73, Sp=0.80) than month-12 (Se=0.48, Sp=0.90). All four patients with HBsAg-seroconversion had profiles with large decreases in qHBsAg (>2 log10 IU/mL), not necessarily occurring during the first 12-months, which was infrequent in patients without seroconversion (8.4%, p<0.001). Conclusions Quantifying hepatitis “e” antigen during the first two-years of TDF-treatment is a practical tool in predicting long-term HBeAg-loss. Non time-specific declines in qHBsAg may be a useful indicator of HBsAg-seroconversion.This article is protected by copyright. All rights reserved
    Liver international: official journal of the International Association for the Study of the Liver 03/2014; · 4.41 Impact Factor


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