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Hepatitis B in the Eurosida Cohort: prevalence, impact on mortality, AIDS progression, and response to HAART
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Reported by Jules Levin
Due to the increased longevity in HIV due to HAART, hepatitis coinfections are receiving much attention. Hepatotoxicities and liver disease progression is a leading cause of death and sickness in HIV. Up until now HCV/HIV coinfection has received much of the attention, but 8-12% of HIV-infected individuals have HBV, although 30% of HIV-infected individuals have HCV. There isn’t much data on the prevalrence of hepatitis B among various subgroups at risk for infection. Transmission occurs through injection drug use and sex. Mother-to-child transmission is a real concern. But we are uncertain of prevalence among some of these populations. It appears many individuals are not tested for HBV and consideration for care and treatment may be not given adequate attention in HIV and among IDUs. With the development of a number of new antivirals, I expect that care and treatment for HBV will be given increasing attention. One important way in which HBV differs from HCV in that 85% of patients spontaneously clear HBV while 85% with HCV go on to chronic HCV infection. Here is a study reported at the European AIDS Conference (October 2003). HCV appears curable based on all current research while HBV so far does not appear curable. There are many more drugs abailable for treating HBV currently and in development. Treatment for HCV is with peginterferon plus ribavirin. Much research is ongoing to find additional drugs for HCV but findings are in the early stages. A number of studies have been conducted and most show HIV accelerates HCV at least 1.5 times faster than for individuals infected with HCV alone. I know of one study conducted in HBV which shows that HIV accelerated HBV I think 5 times faster compared to individuals with HBV alone. I believe this study was conducted in the MACS cohort and was published. It can be found on the NATAP website.
Whether HBV co-infection affects outcome of patients treated with HAART remains unclear. EuroSida is a large group of HIV+ patients in Europe continuosly followed. Eurosida researchers assessed HBsAg (hepatitis B surface antigen) prevalence and survival, clinical progression and response to HAART according to HBsAg status.
Among 5,883 patients tested for HbsAg at time of recruitment in EuroSIDA, 530 patients (9%) were positive. The highest prevalence was found in Argentina (17.8%) vs Northern (9.7%), Central (9.2%), Southern (9.1%) and Eastern Europe (6%) (p=0.0016). There were more males and HIV homosexual transmission among HbsAg-pos subjects (p<0.0001). Median CD4 count at recruitment was lower in HbsAg-pos persons (234) vs HBsAg-neg (274 x 106/l;p<0.0001).
Coinfection with HCV was found in 158 HbsAg-pos (29.8%) and 1363 HBsAg-neg patients (25.5%) (p=0.023). Incidence of any new AIDS diagnosis was higher for HbsAg-pos vs HbsAg-neg subjects (13.1 vs 4.1/100 person-years) but this was not significant after adjustment for CD4, age, AIDS diagnosis, HAART, risk group, gender, ethnic origin, region of Europe, date of recruitment, and HCV status(Poisson regression model).
The incidence of global and liver-related mortality were significantly higher in HbsAg-pos vs HbsAg-neg patients (12 vs 2.6 and 0.5 vs 0.2 /100 person-years respectively), and remained significantly higher in multivariate analysis (including HCV status) with incidence rate ratios of 1.55 (global; 95%CI:1.24-1.93) and 3.77 (liver-related mortality;2.07-6.87). HbsAg status did not influence virological or immunological response among the 1752 subjects starting HAART.
The authors concluded that prevalence of HBV-HIV co-infection is 9% in the EuroSIDA cohort. HBV status does not influence virological and immunological responses to HAART but significantly increases overall and liver-related mortality.
Reference: 9TH EUROPEAN AIDS CONFERENCE (EACS), 1st EACS RESISTANCE & PHARMACOLOGY WORKSHOP, October 25 - 29, 2003 Warsaw, Poland. Oral Abstract: F9/3 - HEPATITIS B (HBV) IN THE EUROSIDA COHORT: PREVALENCE AND IMPACT ON MORTALITY, AIDS PROGRESSION AND RESPONSE TO HAART. Konopnicki D. (1), * De Wit S. (1), Antunes F., Ledergerber B., Katlama C., Zilmer K., Kirk O. (2), Vella S., Mocroft A. (2), Lundgren J.D. (2), for the EuroSIDA Group. (1) Saint-Pierre University Hospital, Brussels, Belgium, (2) Copenhagen HIV Programme, Denmark, (3) University Hospital Zürich, Zürich, Switzerland, (4) Hopital de la Pitié-Salpetriére, Paris, France, (5) West-Tallinn Central Hospital, Tallinn, Estonia, (6) EuroSIDA Coordination Centre, Copenhagen HIV Programme, Hvidovre, Denmark, (7) Istituto superiore di Santà, Rome, Italy, (8) HIV Research Unit, Royal Free and University College Medical Schools, London, UK
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