title: Hepatitis B and C co-infection among HIV-infected adults while on antiretroviral treatment: long-term survival, CD4 cell count recovery and antiretroviral toxicity in Cambodia.
abstract: BACKGROUND
  Despite the high burden, there is a dearth of (long-term) outcome data of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infected patients receiving antiretroviral treatment (ART) in a clinical setting in resource-constrained settings, particularly from Asia.
  
  
  METHODS
  We conducted a retrospective cohort study including all adults initiating standard ART (non-tenofovir-based) between 03/2003 and 09/2012. HBV infection was diagnosed by HBV surface antigen detection. HCV diagnosis relied on antibody detection. The independent effect of HBV and HCV on long-term (≥5 years) ART response in terms of mortality (using Cox regression), severe livertoxicity (using logistic regression) and CD4 count increase (using mixed-effects modelling) was determined.
  
  
  RESULTS
  A total of 3089 adults were included (median age: 35 years (interquartile range 30-41); 46% male), of whom 341 (11.0%) were co-infected with HBV and 163 (5.3%) with HCV. Over a median ART follow-up time of 4.3 years, 240 individuals died. Mortality was 1.6 higher for HBV co-infection in adjusted analysis (P = 0.010). After the first year of ART, the independent mortality risk was 3-fold increased in HCV co-infection (P = 0.002). A total of 180 (5.8%) individuals discontinued efavirenz or nevirapine due to severe livertoxicity, with an independently increased risk for HBV (hazard ratio (HR) 2.3; P<0.001) and HCV (HR 2.8; P<0.001). CD4 recovery was lower in both HBV and HCV co-infection but only statistically significant for HBV (P<0.001).
  
  
  CONCLUSIONS
  HBV and HCV co-infection was associated with worse ART outcomes. The effect of early ART initiation and providing effective treatment for hepatitis co-infection should be explored.
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia ; Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: van Griensven
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Lay
authors.initials: L
authors.lastname: Phirum
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Kimcheng
authors.initials: K
authors.lastname: Choun
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Sopheak
authors.initials: S
authors.lastname: Thai
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: De Weggheleire
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Lynen
mesh_terms: D000328:Adult; D000480:Alkynes; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D048588:Benzoxazines / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count; D002160:Cambodia; D060085:Coinfection / Q000821:virology*; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D006509:Hepatitis B / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D019259:Lamivudine / Q000008:administration & dosage; D008099:Liver / Q000187:drug effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000008:administration & dosage; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018119:Stavudine / Q000008:administration & dosage; D016896:Treatment Outcome; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D000480:Alkynes; D044966:Anti-Retroviral Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; D018119:Stavudine; C098320:efavirenz