Impact of hepatitis B virus infection on the progression of AIDS and mortality in HIV-infected individuals: a cohort study and meta-analysis.
BACKGROUND
The effect of hepatitis B virus (HBV) infection on the natural history of human immunodeficiency virus (HIV) disease remains uncertain. Therefore, a retrospective cohort study was conducted to examine the influence of HIV-HBV coinfection on AIDS development and overall mortality. Moreover, our results were added to those of previous studies in a literature-based meta-analysis.


METHODS
Serum samples obtained from HIV-seropositive patients from 1984 through 2003 were retrospectively tested for hepatitis B surface antigen. Multivariable analyses were performed using Poisson and logistic regression models. For meta-analytic purposes, eligible articles were identified and relevant data were abstracted. Pooled estimates of effect were calculated applying fixed and random effects models.


RESULTS
The prevalence of chronic HBV infection (documented hepatitis B surface antigen seropositivity for >6 months) among 1729 HIV-positive patients was approximately 6%. The multivariable analyses in our primary study revealed no significant impact of concomitant HIV-HBV infection on progression to AIDS and all-cause mortality. However, a meta-analysis performed on data from 12,382 patients enrolled in 11 studies revealed a significant effect of HIV-HBV coinfection on overall mortality (pooled effect estimate, 1.36; 95% confidence interval, 1.12-1.64). The increased rate of death among coinfected individuals was observed in the meta-analyses of studies conducted both before (pooled effect estimate, 1.60; 95% confidence interval, 1.07-2.39) and after (pooled effect estimate, 1.28; 95% confidence interval, 1.03-1.60) commencement of highly active antiretroviral therapy.


CONCLUSIONS
HIV-HBV coinfection seems to affect all-cause mortality, and strategies to reduce liver damage in patients coinfected with HIV and HBV are justified.
Nikolopoulos
Georgios K
GK
Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, University of Athens, Athens GR-11527, Greece.
Paraskevis
Dimitrios
D
Hatzitheodorou
Eleni
E
Moschidis
Zissis
Z
Sypsa
Vana
V
Zavitsanos
Xenophon
X
Kalapothaki
Victoria
V
Hatzakis
Angelos
A
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D044967:Serum / Q000821:virology
D006514:Hepatitis B Surface Antigens