 |
|
|
| |
HBV related complications in HIV positive patients during HAART therapy - LAM resistance and high serum HBV-DNA & advancd liver disease
|
| |
| |
Presented by Irina Magdalena Dumitru (Romania).
I.M. Dumitru1, E. Dumitru1, S. Rugina1, R.C. Cernat2, S. Diaconu2
1Ovidius University Constanta, Faculty of Medicine, Constanta, Romania, 2Clinical Infectious Diseases Hospital, Constanta, Romania
Background: Chronic hepatitis B virus (HBV) infection is overall recognised in 10% of HIV positive persons worldwide, with large differences according to geographical region. Since the widespread use of highly active antiviral therapy (HAART), studies have documented an association between immune reconstitution and alterations in the course of hepatitis B infection. We evaluated the long term evolution of liver disease among patients receiving HAART.
Methods: We followed-up 72 HIV/HBV coinfected patients treated with HAART containing, during a period of five years. Clinical and biological data were collected every 3 months, immunological and virological data every six months, ultrasound every year. Due to availability, in the last year we performed transient elastography (Fibroscan) in every patient. Determination of HBV drug resistance was performed in cases with detectable serum HBV-DNA level.
Results:
Median CD4 count< 230 (110-360)
No patients had signs of liver disease in the begining of the study period.
After five years of follow-up, advanced liver disease was diagnosed in 8/72 patients during follow-up: 5 cirrhosis, 2 hepatocellular carcinoma (HCC), and 1 fulminant hepatitis.
All these patients had high level of serum HBV-DNA, lamivudine resistance and undetectable serum level of HIV.
Five of these patients died. The rest of 64 patients had no signs of active liver diseases (normal or less than 2 x ULN level of ALT, and F0-F1 according to Fibroscan). Lamivudine resistance in these patients was founded in 10 cases.
Conclusions: In HIV/HBV coinfected patients treated with HAART, lamivudine resistance is less frequent (25%) than in immunocompetent patients (higher than 60%), but when occurred, was associated with an accelerated course of liver disease, with faster progression to cirrhosis, liver insufficiency and HCC. Appropriate monitoring of chronic viral hepatitis B in HIV positive patients include the recognition of lamivudine resistence in every case of detectable HBV-DNA level.
|
| |
|
|
|
|
|
