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Hepatitis B Virus Co-infection Affects Baseline HIV Parameters and HAART-related Hepatotoxicity Risk in an HIV-infected Nigerian Cohort
J Idoko1, S Meloni2, M Muazu1, C Hawkins3, B Badung1, N Gwamzi1, P Kanki2, R Murphy3, E Ekong4, and Chloe Thio*5
1Jos Univ Teaching Hosp, Plateau State, Nigeria; 2Harvard Sch of Publ Hlth, Boston, MA, US; 3Northwestern University, Chicago, IL, USA; 4Harvard-PEPFAR Prgm, Lagos, Nigeria; and 5Johns Hopkins Univ, Baltimore, MD, US
Background: Hepatitis B virus
(HBV) co-infection is common in HIV-infected persons, especially in countries
with high HBV endemicity. As ART is introduced into such countries, it is
imperative to understand how HBV affects HIV and ART-related outcomes. We
hypothesized that HBV would increase the risk for ART-related hepatotoxicity
and decrease the response to ART.
Methods: We tested our
hypothesis in persons participating in the PEPFAR program in Nigeria who
initiated ART with stavudine, lamivudine, and nevirapine and who were negative
for HCV antibody. We compared subjects who were co-infected with HBV (HBsAg+)
to those who were HIV mono-infected (HBsAg–) with regards to HIV
parameters and ALT at baseline and after months 3 and 6 of ART. Hepatotoxicity
was defined as ALT > 5x the ULN (41 IU/mL) or >3.5x baseline ALT if ALT
was above ULN at baseline. Nonparametric tests were used to compare groups for
continuous variables and χ2 tests were used for categorical
variables.
Results: Of the 1968
subjects tested, 229 (11.6%) were co-infected with HBV (HIV/HBV), 1170 were
mono-infected with HIV (HIV), and the remainder, who were excluded from this
study, were HIV/HCV or HIV/HBV/HCV-infected. The mean age was 35 years in both
the HIV/HBV and HIV groups. Median CD4 count (cells/mm3) at baseline
was lower in the HIV/HBV group compared to the HIV group (99 vs 132, p <0.0001).
The baseline HIV RNA was significantly higher in the HIV/HBV group (91,529
copies/mL vs 53,278 copies/mL, p = 0.0001). Despite these differences,
the percent of patients with a HIV viral load <400 copies/mL at months 3 or
6 was similar. CD4 counts increased to 220 vs 247 in HIV/HBV vs HIV groups,
respectively (p = 0.02), but the number with a CD4 increase >50 did
not differ (73% and 70%). For patients with baseline and month 6 ALT, mean
baseline ALT was higher in HIV/HBV group (42.9 vs 31.7, p = 0.001). At
month 6, the same ALT difference remained and the cumulative hepatotoxicity was
higher in the HIV/HBV group (4.3%) compared to the HIV group (0.4%, p =
0.007).
Conclusions: HBV co-infection is
common in HIV-infected persons in Nigeria. Prior to ART, the HIV/HBV
group had lower CD4 counts and higher HIV RNA levels, but with 6 months of ART,
their immunological and virological responses were not impaired. The
ART-related hepatotoxicity rates are low, but are increased in HBV
co-infection. Further follow-up is needed to determine longer term effects of
HBV on ART response in this cohort.
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