Description of liver disease in a cohort of HIV/HBV coinfected patients.
BACKGROUND
Factors associated with advanced liver disease have been incompletely explored in HIV/HBV coinfected patients.


OBJECTIVE
To describe liver-related morbidity, mortality, and related risk factors, in HIV/HBV coinfected patients.


METHODS
We followed-up 107 consecutive HIV/HBV coinfected patients. Clinical, biological and virological data were collected every 3 months. Liver-related mortality and a composite score were used to define advanced liver disease.


RESULTS
The patients were mainly sub-Saharan Africans (61%) or Europeans (33%). Forty-four percent of patients had liver biopsy, 78% of patients received lamivudine. Advanced liver disease (ALD) was diagnosed in 19/107 patients during follow-up (mean 4.8 years): 10 extensive fibrosis, 5 cirrhosis, 3 hepatocellular carcinoma resulting from cirrhosis, and 1 fulminant hepatitis following lamivudine withdrawal. Eleven patients died, 4 from HBV-related liver disease. In univariate analysis, male gender, mean HIV and HBV viral loads, and raised AST/ALT transaminases were associated with increased risk of ALD. The strongest associations, in a multivariate model, were mean AST transaminase and cumulated time receiving lamivudine, with a favourable effect. 39% of patients with increased mean AST presented with ALD, versus 7% when normal mean AST (Relative Risk 5.5).


CONCLUSIONS
During HIV/HBV coinfection, transaminase levels are strongly associated with ALD. Normal mean AST has a high negative predictive value, contrary to previously reported data in HIV/HCV patients.
Sellier
P
P
Service de Médecine Interne A, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France. M.Barnes@massey.ac.nz
Schnepf
N
N
Jarrin
I
I
Mazeron
M-C
MC
Simoneau
G
G
Parrinello
M
M
Evans
J
J
Lafuente-Lafuente
C
C
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy / Q000201:enzymology / Q000235:genetics / Q000821:virology*; D006509:Hepatitis B / Q000201:enzymology / Q000235:genetics / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D018709:Statistics, Nonparametric
D019380:Anti-HIV Agents; D004279:DNA, Viral; D019259:Lamivudine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase