title: Hepatitis B Co-Infection is Associated with Poorer Survival of HIV-Infected Patients on Highly Active Antiretroviral Therapy in West Africa.
abstract: BACKGROUND
  Hepatitis B has been reported to be high in HIV-infected African populations. However, the impact of this co-infection on the survival of HIV-infected Africans on long-term highly active antiretroviral therapy (HAART) remains poorly characterised. We investigated the impact of HBV/HIV co-infection on survival of HIV infected patients undergoing antiretroviral therapy in a West African population.
  
  
  METHODS
  This was a clinic-based cohort study of HIV-infected adults enrolled in Nigeria, West Africa. Study subjects (9,758) were screened for hepatitis B and hepatitis C at HAART initiation. Kaplan-Meier survival and Cox proportional hazards models were used to estimate probability of survival and to identify predictors of mortality respectively, based on hepatitis B surface antigen status. All patients had signed an informed written consent before enrolment into the study; and we additionally obtained permission for secondary use of data from the Harvard institutional review board.
  
  
  RESULTS
  Patients were followed up for a median of 41 months (interquartile range: 30-62 months) during which, 181 (1.9%) patients died. Most of the deaths; 143 (79.0%) occurred prior to availability of Tenofovir. Among those that were on antiretroviral therapy, hepatitis B co-infected patients experienced a significantly lower survival than HIV mono-infected patients at 74 months of follow up (94% vs. 97%; p=0.0097). Generally, hepatitis B co-infection: HBsAg-positive/HIV-positive (Hazards Rate [HR]; 1.5: 95% CI 1.09-2.11), co-morbid tuberculosis (HR; 2.2: 95% CI 1.57-2.96) and male gender (HR; 1.5: 95% CI 1.08-2.00) were significantly predictive of mortality. Categorising the patients based on use of Tenofovir, HBV infection failed to become a predictor of mortality among those on Tenofovir-containing HAART.
  
  
  CONCLUSIONS
  HBsAg-positive status was associated with reduced survival and was an independent predictor of mortality in this African HIV cohort on HAART. However, Tenofovir annulled the impact of HBV on mortality of HIV patients in the present study cohort.
authors.affiliation: Hepatology Unit, Department of Medicine, Imperial College London, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom.
authors.forename: Nimzing G
authors.initials: NG
authors.lastname: Ladep
authors.affiliation: AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria.
authors.forename: Oche O
authors.initials: OO
authors.lastname: Agbaji
authors.affiliation: AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria ; Department of Family Medicine, University of Jos, Plateau State, Nigeria.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Agaba
authors.affiliation: AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria.
authors.forename: Auwal
authors.initials: A
authors.lastname: Muazu
authors.affiliation: AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria.
authors.forename: Placid
authors.initials: P
authors.lastname: Ugoagwu
authors.affiliation: AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria.
authors.forename: Godwin
authors.initials: G
authors.lastname: Imade
authors.affiliation: Hepatology Unit, Department of Medicine, Imperial College London, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Cooke
authors.affiliation: Medical Research Council Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, United Kingdom.
authors.forename: Livia
authors.initials: L
authors.lastname: Vivas
authors.affiliation: Medical Research Council Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, United Kingdom.
authors.forename: Sheena Mc
authors.initials: SM
authors.lastname: Cormack
authors.affiliation: Hepatology Unit, Department of Medicine, Imperial College London, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Taylor-Robinson
authors.affiliation: AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria ; National Agency for the Control of AIDS, Plot 823, Ralph Sodeinde Street, CBD, Abuja, Nigeria.
authors.forename: John
authors.initials: J
authors.lastname: Idoko
authors.affiliation: HarvardSchool of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Kanki
keywords: Africa; CD4; HAART; HIV; Hepatitis B surface antigen; Mortality; Survival