title: Characterization of treatment-naive HIV/HBV co-infected patients attending ART clinic of a tertiary healthcare centre in eastern India.
abstract: OBJECTIVE
  The study was designed to assess the hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection scenario among the human immunodeficiency virus (HIV) infected patients attending a tertiary healthcare unit in eastern India. Additionally, clinical and virological characterization of these viruses, prior to antiretroviral therapy (ART) initiation was also done for better understanding of the disease profile.
  
  
  METHODS
  Pool of ART-naive HIV/HBV co-infected and HIV mono-infected patients, participating in two different studies, were included in this study. HBV DNA was detected by nested-PCR amplification followed by HBV genotype determination and HBV reverse transcriptase (RT) region amplification and direct sequencing for detecting drug resistance.
  
  
  RESULTS
  The prevalence of HBsAg (11.3%) was higher compared to anti-HCV (1.9%) among the HIV infected ART-naive patients. Moreover, majority of the HBeAg positive HIV/HBV co-infected patients (87.7%) had HBV DNA ≥20,000 IU/ml with median HBV DNA significantly higher than that of HBeAg negative subjects (5.7 log10 IU/ml vs. 4.2 log10 IU/ml; p<0.0001). Multivariate analysis also showed that HBeAg-positive status was independently associated with higher HBV DNA level (p = <0.001). Notably, 60.9% of the HBeAg negative co-infected subjects had HBV DNA ≥2,000 IU/ml of which 37.0% had HBV DNA ≥20,000 IU/ml. Genotype HBV/D (68.2%) was the predominant genotype followed by HBV/A (24.3%) and HBV/C (7.5%). Anti-HBV drug resistant mutations were detected in two (3.8%) of the ART-naive patients.
  
  
  CONCLUSIONS
  The prevalence of HIV/HBV co-infection was relatively higher in our study subjects. HBeAg testing might provide clue for early treatment initiation. Furthermore, HBeAg negative patients are also associated with high HBV DNA levels and therefore require appropriate medical attention. Pre-treatment screening for anti-HBV drug resistant mutations is not necessary before ART initiation.
authors.affiliation: ICMR Virus Unit, Kolkata, ID & BG Hospital Campus, Kolkata, India.
authors.forename: Debraj
authors.initials: D
authors.lastname: Saha
authors.forename: Ananya
authors.initials: A
authors.lastname: Pal
authors.forename: Avik
authors.initials: A
authors.lastname: Biswas
authors.forename: Rajesh
authors.initials: R
authors.lastname: Panigrahi
authors.forename: Neelakshi
authors.initials: N
authors.lastname: Sarkar
authors.forename: Jayeeta
authors.initials: J
authors.lastname: Sarkar
authors.forename: Manisha
authors.initials: M
authors.lastname: Pal
authors.forename: Subhasish Kamal
authors.initials: SK
authors.lastname: Guha
authors.forename: Bibhuti
authors.initials: B
authors.lastname: Saha
authors.forename: Sekhar
authors.initials: S
authors.lastname: Chakrabarti
authors.forename: Runu
authors.initials: R
authors.lastname: Chakravarty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000150:complications* / Q000188:drug therapy; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006513:Hepatitis B e Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D063128:Tertiary Health Care; D014766:Viremia / Q000150:complications / Q000276:immunology / Q000821:virology; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens
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