Abstract
The morbidity and mortality rates of human immunodeficiency virus (HIV)-hepatitis B virus (HBV) coinfection are higher than that of either infection alone. Outcomes and the virological response to antiretrovirals (combination antiretroviral therapy, cART) were explored in HIV/HBV subjects in a cohort of Italian patients treated with cART. A single-center retrospective analysis of patients enrolled from January 2007 to June 2018 was conducted by grouping patients by HBV status and recording baseline viro-immunological features, the history of virological failure, the efficacy of cART in achieving HIV viral undetectability, viral blip detection and viral rebound on follow up. Among 231 enrolled patients, 10 (4.3%) were HBV surface (s) antigen (HBsAg)-positive, 85 (36.8%) were positive for antibodies to HBV c antigen (HBcAb) and with or without antibodies to HBV s antigen (HBsAb), and 136 were (58.9%) HBV-negative. At baseline, HBcAb/HBsAb+/−-positive patients had lower CD4+ cell counts and CD4+ nadirs (188 cell/mmc, IQR 78–334, p = 0.02 and 176 cell/mmc, IQR 52–284, p = 0,001, respectively). There were significantly higher numbers of AIDS and non-AIDS events in the HBcAb+/HBsAb+/−-positive subjects than in the HBV-negative patients (41.1% vs 19.1%, p = 0.002 and 56.5% vs 28.7%, respectively, p ≤ 0.0001); additionally, HIV viremia undetectability was achieved a significantly longer time after cART was begun in the former than in the latter population (6 vs 4 months, p = 0.0001). Cox multivariable analysis confirmed that after starting cART, an HBcAb+/HBsAb+/−-positive status is a risk factor for a lower odds of achieving virological success and a higher risk of experiencing virological rebound (AHR 0.63, CI 95% 0.46–0.87, p = 0.004 and AHR 2.52, CI 95% 1.09–5.80, p = 0.030). HBcAb-positive status resulted in a delay in achieving HIV < 50 copies/mL and the appearance of viral rebound in course of cART, hence it is related to a poor control of HIV infection in a population of coinfected patients.
Highlights
The morbidity and mortality rates of human immunodeficiency virus (HIV)-hepatitis B virus (HBV) coinfection are higher than that of either infection alone
In our cohort of HIV-positive patients who started combined antiretroviral therapy (cART), the presence of serological markers of a past HBV infection was significantly correlated with a delay in achieving HIV viremia undetectability and the appearance of HIV VR after the start of cART (AHR 2.52, CI 95% 1.09–5.80, p = 0.030 and adjusted hazard ratio (AHR) 0.63, CI 95% 0.46–0.87, p 0.004, respectively)
Lower rates of HBV-resolved infection or chronic hepatitis B (CHB) were found in two American cohorts, which reported values of 23% and 35% in HIV seroconverters and HIV patients on cART, respectively11,12
Summary
The morbidity and mortality rates of human immunodeficiency virus (HIV)-hepatitis B virus (HBV) coinfection are higher than that of either infection alone. HBsAg-positive cART-treated patients demonstrate impaired CD4 recovery and accelerated evolution towards AIDS3 in addition to increased HBV replication, liver disease progression, hepatocellular carcinoma (HCC) prevalence and liver-related mortality. HBsAg-positive cART-treated patients demonstrate impaired CD4 recovery and accelerated evolution towards AIDS3 in addition to increased HBV replication, liver disease progression, hepatocellular carcinoma (HCC) prevalence and liver-related mortality4,5 Based on these data, the European Clinical Practice Guidelines for the management of HBV infection recommended the use of anti-HBV active drugs (NAs) containing cART in HIV-positive patients and strongly suggested avoiding the interruption of this type of treatment. As a component of resolved infection, occult hepatitis B Infection (OBI), which is defined as the absence of the HBs antigen (HBsAg) in the presence of intrahepatic or plasma HBV replication, is known to be a risk factor for the evolution of HBV infection in cirrhosis, ESLD and HCC in immunocompromised patients. Virological and immunological data of patients seen from January 2007 until July 2018 at the Infectious Diseases Unit of the Policlinico Tor Vergata were retrospectively evaluated
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