title: Long-term responses to first-line antiretroviral therapy in HIV and hepatitis B co-infection in Ghana.
abstract: OBJECTIVE
  To observe the long term response to first-line antiretroviral therapy (ART) in HIV and hepatitis B virus (HBV) co-infected patients in Ghana and explore predictors of poor clinical outcomes.
  
  
  METHODS
  Retrospective cohort study of hepatitis B surface antigen (HBsAg) positive and negative patients receiving predominantly NNRTI-based ART with lamivudine plus either zidovudine or stavudine for up to seven years. Cox proportional hazards and Kaplan Meier survival analyses compared clinical outcomes and identified baseline characteristics predictive of poor outcomes. A mixed effects model compared changes in CD4 counts.
  
  
  RESULTS
  A total of 299 HBsAg-positive and 1869 HBsAg-negative patients started ART between 2004 and 2008. Over a median 35 months of follow-up, HBsAg-positive patients were more likely to die or default care than HBsAg-negative patients, aHR 1.36 (95% CI, 1.03-1.80). HBsAg-positive patients were also more likely to develop Grade 3/4 hepatotoxicity than HBsAg-negative patients, HR 1.99 (1.16-3.40) on survival analysis. There was no significant difference in CD4 responses between HBsAg-positive and HBsAg-negative patients.
  
  
  CONCLUSIONS
  HBsAg-positive patients are at significantly increased risk of adverse clinical outcomes after starting ART. Further studies are warranted to evaluate whether these risks remain now that tenofovir is becoming routinely available in Ghana.
authors: Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors: Fred Stephen
authors: FS
authors: Sarfo
authors: Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees TS17 6BH, UK.
authors: Adetayo
authors: A
authors: Kasim
authors: Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors: Richard
authors: R
authors: Phillips
authors: Institute of Global Health, University of Liverpool, L69 7BE, UK.
authors: Anna Maria
authors: AM
authors: Geretti
authors: The James Cook University Hospital, Middlesbrough, TS4 3BW, UK. Electronic address: davidr.chadwick@stees.nhs.uk.
authors: David R
authors: DR
authors: Chadwick
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D005869:Ghana; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006509:Hepatitis B / Q000150:complications* / Q000276:immunology; D006801:Humans; D008099:Liver / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; Clinical outcomes; HIV; Hepatitis B; Lamivudine