Background: Chronic HBV infection might increase risk of HIV progression and mortality in areas where most HBV infection was transmitted by horizontal route before introduction of HAART.

Methods: A prospective observational study was conducted to assess the impact of HBV infection on risk of acute hepatitis (GOT or GPT ³ 5-fold of normal) and hepatic decompensation, virologic and immunologic responses, HIV disease progression, and mortality of non-haemophiliac HIV-infected patients (pts) in Taiwan where vertical HBV transmission was hyperendemic. The Cox-proportional hazards model was used to assess the impact of HBV infection with or without adjustment for age, sex, risk behavior for HIV transmission, year enrolled, baseline CD4⁺ count, PVL, use of antiretroviral therapy. Odds ratios (OR) and 95% CI were also calculated for survival analyses. All tests were two-tailed. A p value < 0.05 was considered significant.

Results: 126 HBV pts (21.7%) (median baseline CD4⁺ count, 0.035 x 10⁹/L; PVL, 5.40 log₁₀ copies/ml) and 455 non-HBV pts (78.3%) (CD4⁺ count, 0.049 x 10⁹/L; PVL, 5.32 log₁₀ copies/ml) were enrolled between June 1994 and June 2002. After a median observation of 2 years, 126 of 581 pts (21.7%) developed acute hepatitis: 34.2% of HBV pts vs 18.5% of non-HBV pts (p = 0.0002). Incidence of acute hepatitis did not increase with introduction of HAART. 15 of 172 pts with HBV or HCV infection (8.7%) developed hepatic decompensation vs. 2 of 387 pts without (0.5%) (OR, 18.392; 95% CI, 4.157-81.364). CD4⁺ increased by 0.072 x 10⁹/L and 0.068 x 10⁹/L (p = 0.79) while PVL decreased by 2.32 log₁₀ copies/ml and 2.57 log₁₀ copies/ml in HBV and non-HBV pts (p = 0.07), respectively, at week 4 of HAART. 22.2% of HBV pts and 23.1% of non-HBV pts developed new AIDS-defining OI (OR, 0.952; 95% CI, 0.593–1.529). The adjusted OR (AOR) for death in HBV pts vs non-HBV pts was 1.035 (95% CI, 0.697–1.538, p = 0.86). Before and after introduction of HAART, the AOR for death in HBV pts was 0.759 (95% CI, 0.328–1.753, p = 0.52) and 1.371 (95% CI, 0.821–2.290, p = 0.23), respectively.

Conclusions: Our data indicated that HIV and HBV co-infected pts treated with ART, especially HAART, had a higher rate of acute hepatitis and hepatic decompensation than non-HBV pts . Risks for HIV progression and mortality and virologic and immunologic responses to HAART were similar.