Abstract
BackgroundChronic hepatitis B (CHB) is a clinical concern in human immunodeficiency virus (HIV)-infected individuals due to substantial prevalence, difficulties to treat, and severe liver disease outcome. A large nationwide cross-sectional multicentre analysis of HIV-HBV co-infected patients was designed to describe and identify parameters associated with virological and clinical outcome of CHB in HIV-infected individuals with detectable HBV viremia.MethodsA multicenter collaborative cross-sectional study was launched in 19 French University hospitals distributed through the country. From January to December 2007, HBV load, genotype, clinical and epidemiological characteristics of 223 HBV-HIV co-infected patients with an HBV replication over 1000 IU/mL were investigated.ResultsPatients were mostly male (82%, mean age 42 years). Genotype distribution (A 52%; E 23.3%; D 16.1%) was linked to risk factors, geographic origin, and co-infection with other hepatitis viruses. This genotypic pattern highlights divergent contamination event timelines by HIV and HBV viruses. Most patients (74.7%) under antiretroviral treatment were receiving a drug with anti-HBV activity, including 47% receiving TDF. Genotypic lamivudine-resistance detected in 26% of the patients was linked to duration of lamivudine exposure, age, CD4 count and HIV load. Resistance to adefovir (rtA181T/V) was detected in 2.7% of patients. Advanced liver lesions were observed in 54% of cases and were associated with an older age and lower CD4 counts but not with viral load or genotype. Immune escape HBsAg variants were seldom detected.ConclusionsDespite the detection of advanced liver lesions in most patients, few were not receiving anti-HBV drugs and for those treated with the most potent anti-HBV drugs, persistent replication suggested non-optimal adherence. Heterogeneity in HBV strains reflects epidemiological differences that may impact liver disease progression. These findings are strong arguments to further optimize clinical management and to promote vaccination in HIV-infected patients.
Highlights
Due to common routes of infection, hepatitis B virus (HBV) and immune deficiency virus (HIV) are found concomitantly in approximately 9% of human immunodeficiency virus (HIV)-seropositive patients in Europe [1]
Persistence of HBV replication is regarded as a deleterious situation in the setting of HBV-HIV coinfection, and recent guidelines recommend to include, in highly-active antiretroviral therapy (HAART), at least one drug active on HBV and preferentially tenofovir disoproxyl fumarate (TDF) [2,3,4]
In HBV low-endemic countries several epidemiologic patterns may be identified: patients who lately acquired HBV are usually infected with HBV strains circulating in their living country, whereas patients originating from highly HBV endemic countries are often infected with an HBV strain acquired during childhood in their original country [5,6]
Summary
Due to common routes of infection, hepatitis B virus (HBV) and immune deficiency virus (HIV) are found concomitantly in approximately 9% of HIV-seropositive patients in Europe [1]. The natural history of HBV infection is complicated in such setting with an increased rate of chronic hepatitis, greater levels of HBV replication and increased incidence of cirrhosis and liver disease-related mortality. In France, the two main characteristics of HBV infection in the general population are a large diversity of epidemiologic patterns and HBV genotypes, and a low vaccine coverage rate, around 40% [5,7,8,9]. A large nationwide cross-sectional multicentre analysis of HIV-HBV co-infected patients was designed to address these issues. Chronic hepatitis B (CHB) is a clinical concern in human immunodeficiency virus (HIV)-infected individuals due to substantial prevalence, difficulties to treat, and severe liver disease outcome. A large nationwide cross-sectional multicentre analysis of HIV-HBV co-infected patients was designed to describe and identify parameters associated with virological and clinical outcome of CHB in HIV-infected individuals with detectable HBV viremia
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