Abstract
ObjectiveThe study was designed to assess the hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection scenario among the human immunodeficiency virus (HIV) infected patients attending a tertiary healthcare unit in eastern India. Additionally, clinical and virological characterization of these viruses, prior to antiretroviral therapy (ART) initiation was also done for better understanding of the disease profile.MethodsPool of ART-naive HIV/HBV co-infected and HIV mono-infected patients, participating in two different studies, were included in this study. HBV DNA was detected by nested-PCR amplification followed by HBV genotype determination and HBV reverse transcriptase (RT) region amplification and direct sequencing for detecting drug resistance.ResultsThe prevalence of HBsAg (11.3%) was higher compared to anti-HCV (1.9%) among the HIV infected ART-naive patients. Moreover, majority of the HBeAg positive HIV/HBV co-infected patients (87.7%) had HBV DNA ≥20,000 IU/ml with median HBV DNA significantly higher than that of HBeAg negative subjects (5.7 log10 IU/ml vs. 4.2 log10 IU/ml; p<0.0001). Multivariate analysis also showed that HBeAg-positive status was independently associated with higher HBV DNA level (p = <0.001). Notably, 60.9% of the HBeAg negative co-infected subjects had HBV DNA ≥2,000 IU/ml of which 37.0% had HBV DNA ≥20,000 IU/ml. Genotype HBV/D (68.2%) was the predominant genotype followed by HBV/A (24.3%) and HBV/C (7.5%). Anti-HBV drug resistant mutations were detected in two (3.8%) of the ART-naive patients.ConclusionThe prevalence of HIV/HBV co-infection was relatively higher in our study subjects. HBeAg testing might provide clue for early treatment initiation. Furthermore, HBeAg negative patients are also associated with high HBV DNA levels and therefore require appropriate medical attention. Pre-treatment screening for anti-HBV drug resistant mutations is not necessary before ART initiation.
Highlights
Human immunodeficiency virus (HIV) infection is a global health problem affecting approximately 40 million people worldwide [1]
In patients co-infected with HIV and hepatitis B virus (HBV) or hepatitis C virus (HCV), liver fibrosis rates are accelerated leading to faster progression to end-stage liver disease (ESLD) [5]
In order to characterize the HIV/HBV co-infection, additional 83 individuals co-infected with HIV and HBV who were treatment naive were further included in the study, along with the above 36 hepatitis B surface antigen (HBsAg) positive subjects, to form an overall pool of 119 HIV/HBV co-infected patients
Summary
Human immunodeficiency virus (HIV) infection is a global health problem affecting approximately 40 million people worldwide [1]. Ever since the introduction of antiretroviral therapy (ART), liver disease has turned out to be the second most relevant cause of mortality among the HIV infected individuals worldwide [4]. In patients co-infected with HIV and HBV or HCV, liver fibrosis rates are accelerated leading to faster progression to end-stage liver disease (ESLD) [5]. Characterization of HBV and HCV coinfection among the HIV infected population is one of the primary foci of the current era. In a resource-poor country like India, such characterization will bring about better understanding of the disease profile and help in developing efficient management strategies to control chronic hepatitis among the HIV infected patients
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