Influence of HIV infection on the response to interferon therapy and the long-term outcome of chronic hepatitis B.
OBJECTIVE
The outcome of chronic hepatitis B and the efficacy of interferon alfa (IFN-alpha) remain controversial in human immunodeficiency virus (HIV)-positive patients. We analyzed the influence of HIV coinfection on the response to IFN-alpha therapy, long-term virologic status, progression to cirrhosis, and mortality.


METHODS
This was a retrospective follow-up cohort study of 141 consecutive hepatitis B e antigen-positive patients (69 HIV positive) followed up for 45 months.


RESULTS
The short-term response to IFN-alpha therapy was not significantly different in HIV-positive and HIV-negative patients (28% vs. 51%; P = 0.06) but was poorer in cases of low CD4 cell count (P = 0.038). The hepatitis B virus (HBV) reactivation rate was higher in HIV-positive patients (P = 0.033) and was associated with low CD4 cell count. The risk of cirrhosis was higher in HIV-positive patients with a CD4 cell count <200/mm(3) (relative risk [RR], 4.57; P = 0.007), in IFN-alpha-untreated patients (RR, 2.63; P = 0.041), in patients older than 33 years (RR, 4.59; P = 0.008), and in cases of high necroinflammatory score at baseline (RR, 1.27; P = 0.010). Cirrhosis-related death was more frequent in HIV-positive patients with low CD4 cell count at baseline (P = 0.041), in alcohol consumers (P = 0.001), in IFN-alpha-untreated patients (P = 0.052), and in patients with high histology activity index at baseline (P = 0.005).


CONCLUSIONS
HIV coinfection was associated with poorer response to IFN-alpha therapy, more frequent HBV reactivations, and increased incidence of cirrhosis and cirrhosis-related death in cases of low CD4 count. IFN-alpha therapy decreased the incidence of HBV cirrhosis regardless of HIV status or serologic response.
Di Martino
Vincent
V
Service d'Hépatologie, INSERM U481 et Centre de Recherche Claude Bernard sur les hépatites virales, Hôpital Beaujon AP-HP, Clichy, France.
Thevenot
Thierry
T
Colin
Jean-François
JF
Boyer
Nathalie
N
Martinot
Michèle
M
Degos
Françoise
F
Coulaud
Jean-Pierre
JP
Vilde
Jean-Louis
JL
Vachon
François
F
Degott
Claude
C
Valla
Dominique
D
Marcellin
Patrick
P
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D018450:Disease Progression; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D018023:HIV Seronegativity; D006510:Hepatitis B Antibodies / Q000032:analysis; D006515:Hepatitis B virus / Q000187:drug effects / Q000502:physiology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology; D008137:Longitudinal Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D019562:Viral Load; D014775:Virus Activation
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D016898:Interferon-alpha