Hepatitis B and long-term HIV outcomes in coinfected HAART recipients.
BACKGROUND
Chronic hepatitis B (CH-B) is common among HIV-infected individuals and increases liver-related mortality in the absence of HAART. The impact of CH-B on long-term HAART outcomes has not been fully characterized.


METHODS
To address this question, HAART initiators enrolled in the Multicenter AIDS Cohort Study were retrospectively analyzed. Patients were classified by hepatitis B category based on serology at the time of HAART initiation. The association of CH-B with mortality, AIDS-defining illnesses, CD4 cell rise, and HIV suppression was assessed using regression analysis.


RESULTS
Of 816 men followed for a median of 7 years on HAART, 350 were never hepatitis B virus (HBV) infected, 357 had past infection, 45 had CH-B, and 64 were only core-antibody positive. Despite HAART, AIDS-related mortality was the most common cause of death [8.3/1000 person-years (PYs)]. It was highest in those with CH-B (17/1000 PYs, 95% confidence interval 7.3, 42) and lowest among never HBV infected (2.9/1000 PYs, 95% confidence interval 1.4, 6.4). In a multivariable model, patients with CH-B had a 2.7-fold higher incidence of AIDS-related mortality compared with those never infected (P = 0.08). Non-AIDS-related mortality was also highest among those with CH-B (22/1000 PYs), primarily due to liver disease (compared to never infected, adjusted hazard ratio 4.1, P = 0.04). There was no significant difference in AIDS-defining events, HIV RNA suppression, and CD4 cell increase.


CONCLUSIONS
In HIV-infected patients receiving long-term HAART, HBV status did not influence HIV suppression or CD4 cell increase. However, mortality was highest among those with CH-B and was mostly due to liver disease despite HBV-active HAART.
Hoffmann
Christopher J
CJ
Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA. choffmann@jhmi.edu
Seaberg
Eric C
EC
Young
Stephen
S
Witt
Mallory D
MD
D'Acunto
Kristin
K
Phair
John
J
Thio
Chloe L
CL
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D015497:HIV-1 / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000401:mortality; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D012367:RNA, Viral