Abstract
BackgroundDespite the high burden, there is a dearth of (long-term) outcome data of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infected patients receiving antiretroviral treatment (ART) in a clinical setting in resource-constrained settings, particularly from Asia.MethodsWe conducted a retrospective cohort study including all adults initiating standard ART (non-tenofovir-based) between 03/2003 and 09/2012. HBV infection was diagnosed by HBV surface antigen detection. HCV diagnosis relied on antibody detection. The independent effect of HBV and HCV on long-term (≥5 years) ART response in terms of mortality (using Cox regression), severe livertoxicity (using logistic regression) and CD4 count increase (using mixed-effects modelling) was determined.ResultsA total of 3089 adults were included (median age: 35 years (interquartile range 30–41); 46% male), of whom 341 (11.0%) were co-infected with HBV and 163 (5.3%) with HCV. Over a median ART follow-up time of 4.3 years, 240 individuals died. Mortality was 1.6 higher for HBV co-infection in adjusted analysis (P = 0.010). After the first year of ART, the independent mortality risk was 3-fold increased in HCV co-infection (P = 0.002). A total of 180 (5.8%) individuals discontinued efavirenz or nevirapine due to severe livertoxicity, with an independently increased risk for HBV (hazard ratio (HR) 2.3; P<0.001) and HCV (HR 2.8; P<0.001). CD4 recovery was lower in both HBV and HCV co-infection but only statistically significant for HBV (P<0.001).DiscussionHBV and HCV co-infection was associated with worse ART outcomes. The effect of early ART initiation and providing effective treatment for hepatitis co-infection should be explored.
Highlights
Despite the high burden, there is a dearth of outcome data of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infected patients receiving antiretroviral treatment (ART) in a clinical setting in resource-constrained settings, from Asia
Based on carefully collected program data over a period of ten years, we report on the prevalence of HBV and HCV co-infection, and the effect on ART response in term of CD4 cell count recovery, allcause mortality and ART-related drug toxicity in adult patients on ART in Cambodia
There were 182 individuals discontinuing ART due to skin rash, but there was no statistically significant difference for neither HBV nor HCV co-infection. This is one of the few studies reporting on long-term ART treatment outcomes from a program setting in a low income country in South-East Asia
Summary
There is a dearth of (long-term) outcome data of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infected patients receiving antiretroviral treatment (ART) in a clinical setting in resource-constrained settings, from Asia. Asia carries the largest burden, and hosts a total of 5 million HIV infected individuals [1,6,7] Both viral hepatitis infections are associated with more rapid progression of liver fibrosis in the event of HIV co-infection and liver pathology has been identified as a leading causes of death in high-income countries [1,8,9]. In these countries, HBV and HCV treatment, following specific indications, is part of the HIV care package
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