822 The Impact of Prior Hepatitis B Virus Infection on Histologic Lesions in HIV and Hepatitis C Virus Co-infected Patients Y. Benhamou*, R. P. Myers, V. Thibault, S. Dominguez, M. A. Valantin, A. Simon, F. Braicaire, C. Katlama, T. Poynard Groupe Hosp Pitié-Salpêtrière, Paris, France
Background: HIV and hepatitis C virus (HCV) co-infected patients (pts) frequently have antibodies to the hepatitis B core antigen (anti-HBc), indicative of prior hepatitis B virus (HBV) infection. In these pts, persistence of HBV may have a detrimental effect on liver histology.
Aim: The objective of this study was to evaluate the relationship between anti-HBc status and histologic lesions in HIV/HCV co-infected pts.
Methods: Liver histology was evaluated in 145 treatment-naïve, hepatitis B surface antigen-negative, HIV/HCV co-infected pts. The impact of anti-HBc-positivity on necro-inflammatory activity (A2-A3 by the METAVIR classification) and progression to septal fibrosis (F2-F4) was determined via multivariate analyses.
Results: The median age was 36 yrs (range, 26-57), 75% were male, and 78% were anti-HBc-positive. Serum ALT and necro-inflammatory activity did not differ between anti-HBc-positive and negative pts. However, progression to septal fibrosis was slower in anti-HBc-positive pts (log-rank, p = 0.006), particularly those with CD4 counts less than 200 cells/mm3 (p = 0.009). After controlling for alcohol consumption, necro-inflammatory activity, steatosis, CD4 count, and HCV genotype, Cox proportional hazards analysis identified anti-HBc-positivity as an independent protective factor against progression to septal fibrosis (relative risk, 0.31; 95% confidence interval, 0.15 to 0.67). The protective effect of anti-HBc positivity persisted when adjusted for lamivudine therapy, suggesting the involvement of mechanisms independent of HBV replication.
Conclusions: Previous HBV infection does not have a detrimental impact on histologic lesions in HIV/HCV-co-infected pts. A potential protective effect of anti-HBc positivity on fibrosis progression, particularly in those with advanced immunosuppression, warrants confirmation.