title: Characterization of HIV-HBV coinfection in a multinational HIV-infected cohort.
abstract: OBJECTIVE
  To understand the HIV-hepatitis B virus (HBV) epidemic from a global perspective by clinically and virologically characterizing these viruses at the time of antiretroviral therapy (ART) initiation in a multinational cohort.
  
  
  METHODS
  HIV-infected patients enrolled in two international studies were classified as HIV-HBV coinfected or HIV monoinfected prior to ART. HIV-HBV coinfected patients were tested for HBV characteristics, hepatitis D virus (HDV), a novel noninvasive marker of liver disease, and drug-resistant HBV. Comparisons between discrete covariates used χ or Fisher's exact tests (and Jonchkheere-Terpstra for trend tests), whereas continuous covariates were compared using Wilcoxon Rank-Sum Test.
  
  
  RESULTS
  Of the 2105 HIV-infected patients from 11 countries, the median age was 34 years and 63% were black. The 115 HIV-HBV coinfected patients had significantly higher alanine aminotransferase and aspartate aminotransferase values, lower BMI, and lower CD4 T-cell counts than HIV monoinfected patients (median 159 and 137 cells/μl, respectively, P = 0.04). In the coinfected patients, 49.6% had HBeAg-negative HBV, 60.2% had genotype A HBV, and 13% were HDV positive. Of the HBeAg-negative patients, 66% had HBV DNA 2000 IU/ml or less compared to 5.2% of the HBeAg-positive individuals. Drug-resistant HBV was not detected.
  
  
  CONCLUSIONS
  Screening for HBV in HIV-infected patients in resource-limited settings is important because it is associated with lower CD4 T-cell counts. In settings in which HBV DNA is not available, HBeAg may be useful to assess the need for HBV treatment. Screening for drug-resistant HBV is not needed prior to starting ART in settings in which this study was conducted.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland 21205, USA. cthio@jhmi.edu
authors.forename: Chloe L
authors.initials: CL
authors.lastname: Thio
authors.forename: Laura
authors.initials: L
authors.lastname: Smeaton
authors.forename: Melissa
authors.initials: M
authors.lastname: Saulynas
authors.forename: Hyon
authors.initials: H
authors.lastname: Hwang
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Saravanan
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Saravan
authors.forename: Smita
authors.initials: S
authors.lastname: Kulkarni
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.forename: Mulinda
authors.initials: M
authors.lastname: Nyirenda
authors.forename: Hussain S
authors.initials: HS
authors.lastname: Iqbal
authors.forename: Umesh G
authors.initials: UG
authors.lastname: Lalloo
authors.forename: Anand S
authors.initials: AS
authors.lastname: Mehta
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hollabaugh
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.forename: Judith S
authors.initials: JS
authors.lastname: Currier
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy; D006514:Hepatitis B Surface Antigens; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens