title: Description of liver disease in a cohort of HIV/HBV coinfected patients.
abstract: 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.
authors.affiliation: Service de Médecine Interne A, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France. M.Barnes@massey.ac.nz
authors.forename: P
authors.initials: P
authors.lastname: Sellier
authors.forename: N
authors.initials: N
authors.lastname: Schnepf
authors.forename: I
authors.initials: I
authors.lastname: Jarrin
authors.forename: M-C
authors.initials: MC
authors.lastname: Mazeron
authors.forename: G
authors.initials: G
authors.lastname: Simoneau
authors.forename: M
authors.initials: M
authors.lastname: Parrinello
authors.forename: J
authors.initials: J
authors.lastname: Evans
authors.forename: C
authors.initials: C
authors.lastname: Lafuente-Lafuente
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D019259:Lamivudine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase