| Title | Hepatitis B and long-term HIV outcomes in coinfected HAART recipients. | | Author(s) | Hoffmann CJ, Seaberg EC, Young S, Witt MD, Dʼacunto K, Phair J, Thio CL | | Institution | aDivision of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, USA bDivision of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA cUniversity of New Mexico School of Medicine, Albuquerque, New Mexico, USA dDavid Geffen School of Medicine at UCLA, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA eDepartment of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA fDivision of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. | | Source | AIDS 2009 Jun 22. | | 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. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19550291 |
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