title: Improved immune status corresponds with long-term decline of quantitative serum hepatitis B surface antigen in HBV/HIV co-infected patients.
abstract: In HBV/HIV-co-infected individuals, the course of hepatitis B is aggravated, leading to higher morbidity and mortality rates. Increasing evidence suggests an important role for hepatitis B surface antigen (HBsAg) quantification in monitoring treatment efficacy in HBV monoinfection. However, data concerning any HBsAg decline during treatment of HBV/HIV coinfection are limited. Fifty-one HBV/HIV-co-infected patients were retrospectively followed for a mean of 43 months (median 2 years, interquartile range 2 years). Baseline and on-treatment parameters were associated with longitudinal HBsAg levels. At baseline, serum HBsAg levels were comparable between patients on antiretroviral therapy (ART; n=43) and patients without (n=8). Longitudinally, HBsAg decreased in ART patients (-0.20±0.09 log(10) IU/mL/y), but slightly increased in subjects without therapy (0.22±0.26 log(10) IU/mL/y; p<0.001). In 58% of the ART subjects an HBsAg decline >10% was seen during the initial 24 mo. They showed higher baseline CD4 counts (401±42 versus 265±50 cells/μL, p=0.03), and had significantly higher CD4 counts at the last follow-up compared to patients without a decline (506±39 versus 310±51 cells/μL, p=0.01). A significant correlation was found between HBsAg decline from baseline to the last follow-up and the absolute increase of CD4 cells (r=0.44, p=0.003), as well the last CD4 count (r=0.41, p=0.006). This association was strongest in patients with complete suppression of HBV-DNA and HIV-RNA at the last follow-up visit. The highest HBsAg decline (-1.63±0.32 versus -0.43±0.24 log(10) IU/mL, p=0.001), and yearly HBsAg decline (-0.47±0.13 versus -0.19±0.12 log(10) IU/mL, p=0.03), were found in patients with CD4 increases >100 cells/μL at the last follow-up (n=21, 49%). Four cases of HBsAg loss were observed (8%). HBsAg declines steadily in >50% of HBV/HIV patients on ART. Long-term follow-up of HBV/HIV-co-infected patients is needed to identify distinct HBsAg patterns. Increasing CD4 counts indicating the restoration of immune competence in HBV/HIV-co-infected patients is associated with a stronger HBsAg decline.
authors.affiliation: Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany.
authors.forename: Eduard
authors.initials: E
authors.lastname: Arendt
authors.forename: Jerzy
authors.initials: J
authors.lastname: Jaroszewicz
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rockstroh
authors.forename: Dirk
authors.initials: D
authors.lastname: Meyer-Olson
authors.forename: Behrend J
authors.initials: BJ
authors.lastname: Zacher
authors.forename: Ingmar
authors.initials: I
authors.lastname: Mederacke
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
authors.forename: Markus
authors.initials: M
authors.lastname: Cornberg
authors.forename: Karsten
authors.initials: K
authors.lastname: Wursthorn
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000097:blood; D016903:Drug Monitoring; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D044967:Serum / Q000821:virology*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral