Do HIV care providers appropriately manage hepatitis B in coinfected patients treated with antiretroviral therapy?
BACKGROUND
The common occurrence of hepatitis B virus (HBV) infection in patients who carry the human immunodeficiency virus (HIV) demands that both viruses be recognized, evaluated, and treated when appropriate.


METHODS
We identified 357 HIV- and hepatitis B surface antigen-positive patients who underwent testing from 1999 to 2003; 155 patients who were new to our clinic and who initiated therapy for HIV and HBV coinfection were considered for inclusion in the study. The frequency of HIV testing (to determine HIV load and CD4+ cell count) performed during the first year of therapy was compared with the frequency of HBV measurements (to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load), abdominal ultrasound examination, and measurement of levels of alpha-fetoprotein in serum.


RESULTS
HBV load data were obtained for only 16% of patients before initiation of antiretroviral therapy (ART), whereas HIV load was determined for 99% of patients before initiation of ART. The total number of HIV load measurements obtained during the first year after ART initiation was 497 (median number of HIV load measurements per patient, 3.0), compared with 85 measurements of HBV load (median number of HBV load measurements per patient, <1; P<.001). The percentage of patients who received any level of HBV monitoring (i.e., tests to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load) after ART initiation increased from 7% in 1999 to 52% in 2001 (P<.001), whereas the percentage of patients who underwent HIV load testing remained at 80%-90% during the same period.


CONCLUSIONS
Health care providers treating patients with HIV infection during the period 1999-2003 infrequently monitored HBV response in coinfected patients, but they systematically monitored HIV response after ART initiation. Improved physician adherence to guidelines that better delineate HBV treatment and monitoring for patients with HIV-HBV coinfection is needed.
Jain
Mamta K
MK
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9113, USA. Mamta.Jain@utsouthwestern.edu
Opio
Christopher K
CK
Osuagwu
Chukwuma C
CC
Pillai
Rathi
R
Keiser
Philip
P
Lee
William M
WM
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000592:standards* / Q000639:trends; D006509:Hepatitis B / Q000175:diagnosis* / Q000188:drug therapy*; D006513:Hepatitis B e Antigens / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards / Q000639:trends; D020380:Needs Assessment; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019562:Viral Load
D000998:Antiviral Agents; D006513:Hepatitis B e Antigens