title: Impact of hepatitis D virus infection on the long-term outcomes of patients with hepatitis B virus and HIV coinfection in the era of highly active antiretroviral therapy: a matched cohort study.
abstract: BACKGROUND
  Triple infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis D virus (HDV) is rare. The influence of HDV infection on the responses to highly active antiretroviral therapy and hepatic complications in patients with HBV-HIV coinfection remains uncertain.
  
  
  METHODS
  Twenty-six HDV-infected case patients and 78 HDV-uninfected matched control subjects were identified between 1 January 1995 and 30 June 2003. Clinical and immunologic outcomes were noted, and HBV and HIV loads and genotypic resistance of HBV to lamivudine were determined.
  
  
  RESULTS
  Case patients had a higher rate of injection drug use (7.7% vs. 1.3%; P=.05) and lower serum levels of HBV DNA (median level, 4.04 vs. 5.75 log10 copies/mL; P=.07) than control subjects. During a median observation period of 54.7 months, HDV infection did not have an adverse impact on clinical, virological, or immunologic responses to highly active antiretroviral therapy. However, case patients had higher rates of hepatitis flares (57.7% vs. 23.1%; P=.002), hyperbilirubinemia (34.6% vs. 14.1%; P=.04), liver cirrhosis (26.9% vs. 5.1%; P=.009), hepatic decompensation (23.1% vs. 5.1%; P=.007), and death (adjusted hazard ratio, 5.41; 95% confidence interval, 1.39-23.85; P=.02), although these patients had a lower risk of genotypic resistance to lamivudine (0% vs. 57.1%; P=.003).
  
  
  CONCLUSIONS
  HDV infection did not affect clinical, virological, or immunologic responses to highly active antiretroviral therapy in patients with HBV-HIV coinfection. HDV infection increased risk of hepatitis flares, liver cirrhosis, hepatic decompensation, and death in patients with HBV-HIV coinfection.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Jia-Horng
authors.initials: JH
authors.lastname: Kao
authors.forename: Sui-Yuan
authors.initials: SY
authors.lastname: Chang
authors.forename: Mao-Yuan
authors.initials: MY
authors.lastname: Chen
authors.forename: Szu-Min
authors.initials: SM
authors.lastname: Hsieh
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000998:Antiviral Agents / Q000627:therapeutic use; D015897:Comorbidity; D016001:Confidence Intervals; D004279:DNA, Viral; D005260:Female; D005500:Follow-Up Studies; D006515:Hepatitis B virus / Q000187:drug effects / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003699:Hepatitis D / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003698:Hepatitis Delta Virus / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011336:Probability; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral