title: Hepatitis B virus and HIV coinfection: relationship of different serological patterns to survival and liver disease.
abstract: OBJECTIVE
  Eighty per cent of HIV-positive patients show evidence of past or current infection with hepatitis B virus (HBV). The impact of chronic HBV infection or the presence of isolated HBV core antibody on survival in the era of highly active antiretroviral therapy (HAART) has not been well studied.
  
  
  METHODS
  This retrospective analysis included patients from the HIV Atlanta Veterans Affairs Cohort Study (HAVACS). This cohort comprises 2818 HIV-positive patients followed since 1982. For this analysis, 1685 patients with available HBV serologies were included, based on laboratory records available since 1992. Adjusted survival analyses were performed for patients showing any of four serological patterns for HBV: (1) surface antigen positive (chronic HBV infection), (2) isolated core antibody, (3) surface antibody with or without core antibody (resolved/vaccinated) and (4) no HBV markers (negative group). Risk factors for liver disease were identified.
  
  
  RESULTS
  A trend was seen for a lower survival rate from AIDS to death in the chronic HBV infection group compared with the negative group [hazard ratio (HR) 1.43; P=0.118]. The only independent predictor of lower survival rate was hepatitis C virus positivity (HR 1.62; P=0.008). Protective factors were use of HAART (HR 0.40; P=0.0003), use of lamivudine (HR 0.36; P<0.0001) and use of tenofovir (HR 0.23; P<0.0001). Survival from HIV diagnosis to death was not different among the HBV groups. Isolated core antibody patients did not have a lower survival rate compared with those with resolved HBV infection. Patients with chronic HBV infection were 3.5 times more likely to have liver disease than those with no HBV infection (P<0.02).
  
  
  CONCLUSIONS
  There is a trend towards a lower survival rate in patients with HIV and chronic HBV infection, but the difference did not reach statistical significance. The presence of isolated core antibody was not associated with a lower survival rate.
authors.affiliation: School of Medicine, Emory University, Division of Infectious Diseases, Atlanta, GA 30308, USA. mkosbor@emory.edu
authors.forename: M K
authors.initials: MK
authors.lastname: Osborn
authors.forename: J L
authors.initials: JL
authors.lastname: Guest
authors.forename: D
authors.initials: D
authors.lastname: Rimland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D001219:Aspartate Aminotransferases / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005845:Georgia; D006678:HIV / Q000254:growth & development*; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006512:Hepatitis B Core Antigens / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000254:growth & development*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000276:immunology / Q000821:virology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D001219:Aspartate Aminotransferases