title: HBV coinfection is associated with reduced CD4 response to antiretroviral treatment in pregnancy.
abstract: To evaluate the impact of Hepatitis B virus (HBV) coinfection on response to antiretroviral treatment in pregnant women with HIV.
  
  
  
  Retrospective analysis of a large case series of pregnant women with HIV in Italy; outcome measures were CD4 changes, HIV viral load, and main pregnancy outcomes (preterm delivery, low birthweight, intrauterine growth restriction, mode of delivery, and major birth defects).
  
  
  
  Rate of HBV coinfection among 1462 pregnancies was 12.0%. Compared to the HBV-uninfected, HBV-coinfected women had a significantly lower median CD4 cell gain between first and third trimester (26.5 vs. 60 cells/mm3, p = 0.034), with similar rate of undetectable (<50 copies/ml) HIV-RNA at third trimester (70.5% vs. 65.2%, p = 0.229), and no differences in all the main maternal and infant outcomes. A multivariable linear regression analysis identified four variables significantly and independently associated with a lower CD4 response in pregnancy: HBV coinfection (-35 cells/mm3), being on antiretroviral treatment at conception (-59.7 cells/mm3), AIDS status (-59.8 cells/mm3) and higher first CD4 levels in pregnancy (-0.24 cells per unitary CD4 increase).
  
  
  
  HBV coinfection had no adverse influence on the main pregnancy outcomes or on HIV viral load suppression in late pregnancy but was associated with a significantly reduced CD4 response in pregnancy. This effect might have clinical relevance, particularly in women with advanced immune deterioration.
authors.affiliation: a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Floridia
authors.affiliation: b Department of Obstetrics and Neonatology , Città della Salute e della Scienza Hospital, and University of Turin , Turin , Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Masuelli
authors.affiliation: c Department of Infectious Diseases , Catholic University , Rome , Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Tamburrini
authors.affiliation: d Department of Obstetrics and Gynaecology , IRCCS S. Matteo , Pavia , Italy.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.affiliation: e Department of Medical and Surgical Sciences , Policlinico Sant'Orsola-Malpighi and University of Bologna , Bologna , Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Simonazzi
authors.affiliation: f Department of Medical Specialties, Infectious Diseases Clinic , University of Modena and Reggio Emilia , Modena , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.affiliation: g Department of Infectious Diseases and Hepatology , Azienda Ospedaliera di Parma , Parma , Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Degli Antoni
authors.affiliation: h Department of Neurosciences, Reproductive and Dentistry Science , University Federico II Naples , Naples , Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Martinelli
authors.affiliation: i Infectious Diseases Unit , S. Antonio Abate Hospital , Trapani , Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Portelli
authors.affiliation: j Department of Obstetrics and Gynaecology , DMSD San Paolo Hospital Medical School, University of Milan , Milan , Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Dalzero
authors.affiliation: j Department of Obstetrics and Gynaecology , DMSD San Paolo Hospital Medical School, University of Milan , Milan , Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Ravizza
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology* / Q000378:metabolism; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D019562:Viral Load
keywords: Antiretroviral treatment; CD4 response; HBV; HIV; HIV viral load; Pregnancy; Pregnancy outcomes; Preterm delivery