A prospective cohort study of immunologic and virologic outcomes in patients with HIV/AIDS and hepatitis virus co-infection in Jos, Nigeria.
BACKGROUND
In this era of highly active antiretroviral therapy (HAART), hepatitis B and C virus (HBV and HCV) co-infection have emerged as significant co-morbid conditions. Local reports indicate that co-infection is not uncommon in Nigeria as in other sub-Saharan African countries. Whether treatment outcomes of HIV mono-infected patients differ from those with co-infection remains largely unknown. We hypothesised that co-infected patients will have lower CD4+ count recovery and viralload reduction following HAART.


METHODS
A cohort study in antiretroviral therapy-naïve HIV-infected adults involving 150 cases (HIV and co-infection) and 150 controls (HIV infection only). Patients' care was according to the National guidelines and patients received first line therapy mostly comprising Lamivudine, Stavudine and Nevirapine. Medication adherence was monitored using pharmacy computerised system, and CD4+ cell counts and HIV viral load (VL) were compared at baseline, 3 and 6 months of therapy


RESULTS
There were 98 (65.3%) and 96 (64%) female cases and controls (p = 0.79) respectively. The mean ages of cases and controls were 38 +/- 8.4 and 37 +/- 8.9 years (p = 0.20) respectively. Cases comprised 73 (48%) HBV, 70 (47%) HCV and 7 (5%) with both HBV and HCV infection. Medication adherence was > 95% in both arms. Attrition rate was 2.7% (8); seven of them were co-infected. Five cases (3.3%) compared to zero controls developed clinical hepatitis. The proportions of patients with CD4+ count < 200 cells/microl among cases and controls were 111 (74%) and 109 (72%), p = 0.36 at baseline; 66 (45.5%) and 64 (42.7%), p = 0.21 at 3 months; 60 (42%) and 56 (37.6%), p = 0.40 at 6 months respectively. Significantly more controls (60.7%) had CD4+ increases 50 cells/microl at 3 months compared to 37 (54.5%) HCV+ cases (p = 0.03). No significant difference in CD4+ counts between controls and cases at 6 months. The baseline median VL for cases and controls were log(10)4.95 and log(10)4.83 (p = 0.17) respectively. The proportions of cases and controls with undetectable VL at 3 and 6 months were 96 (66.2%) and 97 (65.5%); p = 0.74, and 116 (81.1%) and 97 (79.3%); p = 0.010 respectively.


CONCLUSIONS
Co-infection has limited impact on immunologic and virologic outcomes, but may be an important cause of hepatotoxicity.
lsa
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Federal Medical Center, Keffi, Nigeria. ejijisa@yahoo
Gwamzhi
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LN
Akolo
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Giyan
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J
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology; D006506:Hepatitis A / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006785:Hospitals, University; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult