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Hepatitis D Virus Can Worsen the Outcome of HBV-HIV Coinfected Patients
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Reported by Jules Levin
The effect of hepatitis D virus (HDV) infection on outcomes of patients with hepatitis B virus (HBV) and HIV co-infection who were treated with ART remains unclear.
Between January 1, 1995 and June 30, 2003, investigators from Taiwan enrolled 26 patients with HDV/HBV/HIV co-infection (HDV-infected patients) and 78 with HBV/HIV co-infection only (HDV-uninfected patients) who were matched with age, sex, baseline CD4+ lymphocyte count and liver disease status. The development of hepatitis flare, liver cirrhosis, and hepatic decompensation; virologic, immunologic, and clinical responses to HAART; and mortality were compared. HBV DNA and genotypic resistance to lamivudine (YMDD mutation) were determined.
HDV-infected patients had a higher proportion of HIV transmission by intravenous drug use (7.7% vs 1.3%, p = 0.05). During a median observation duration of 54.7 months (range, 1.6 to 115.7 months), HDV-infected patients were more likely to have clearance of HBs antigenemia (p = 0.02); less likely to be positive for HBV DNA at baseline (p = 0.03); and less likely to develop genotypic resistance to lamivudine (p = 0.003); however, they had more episodes of hepatitis flares (p = 0.001) and hyperbilirubinemia (p = 0.04); and were more likely to develop liver cirrhosis (p = 0.005) and hepatic decompensation (p = 0.002).
HDV-infected patients were at higher risk for deaths when compared with HDV-uninfected patients with a hazard ratio of 5.55 (95% confidence interval, 1.43 to 21.58, p = 0.01). The immunologic responses in terms of increase of CD4+ lymphocyte count (p = 0.69), development of new AIDS-defining opportunistic illnesses (p = 0.14), achievement of undetectable plasma HIV RNA load (p = 0.11) and ever having virologic failure (p = 0.20) was similar between HDV-infected and HDV-uninfected patients.
Among patients with both chronic HBV and HIV co-infection, superinfection with HDV did not increase the risk for HIV progression and had no adverse effect on virologic and immunologic responses to HAART. However, HDV-infected patients had higher episodes of hepatitis flares and were at increased risk for development of liver cirrhosis, hepatic decompensation, and mortality when HAART initiated.
Reference
Clinical and Virologic Efffect of Chronic Hepatitis D Virus Infection on Patients with Hepatitis B and HIV Co-infection in the Era of HAART. Wang-Huei Sheng*, C C Hung, J H Kao, M Y Chen, S M Hsieh, P J Chen, and S C Chang, Natl Taiwan Univ Hosp, Taipei, 13th Conference on Retroviruses and Opportunistic Infections (CROI), feb 5-8, 2006, Denver, CO. abstract 838.
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