1029
Death, HIV Suppression, and CD4 Recovery among HIV/HBV-co-infected Men Receiving ART: MACS
Christopher Hoffmann*1, E Seaberg2, K D'Acunto3, M Witt4, J Phair5, and C Thio1
1Johns Hopkins Univ Sch of Med, Baltimore, MD, US; 2Johns Hopkins Univ Bloomberg Sch of Publ Hlth, Baltimore, MD, US; 3Univ of Pittsburgh Sch of Publ Hlth, PA, US; 4David Geffen Sch of Med, Univ of California, Los Angeles, US; and 5Feinberg Sch of Med, Northwestern Univ, Chicago, IL, US
Background: Chronic hepatitis B virus (HBV) is common among
HIV-infected individuals. However, the long-term effect of chronic HBV on HIV
RNA suppression, CD4 rise, and mortality during ART remains uncertain. Using a
cohort of HIV/HBV co-infected and HIV mono-infected subjects receiving ART, we determined
the effect of HBV on CD4 rise, HIV RNA suppression, and AIDS-related and non-AIDS-related
mortality during long-term ART.
Methods: Subjects from the prospective observational Multicenter
AIDS Cohort Study (MACS) who initiated ART after MACS enrolment were included
if they had adequate HBV serologic information to be stratified as never
infected (HBcAb–), past infection (HBsAb+ and HBcAb+),
chronic HBV (HBsAg+ on 2 separate visits), and HBcAb+
only (possible occult HBV). All-cause mortality, AIDS-related-mortality, and
non-AIDS-related mortality, including liver-related, were modeled using
survival analysis. HIV RNA suppression was modeled using generalized estimating
equations and CD4 recovery using mixed linear equations.
Results: We followed 822 men with a median age of 34 for a
median of 8.5 years on ART: 354 were never infected with HBV, 359 had past infection,
45 had chronic HBV, and 64 had HBcAb+ only. Of the 64 with HBcAb+
only, 7 had detectable HBV DNA. AIDS deaths were not increased among any of the
4 HBV strata; however, non-AIDS deaths adjusted for age, CD4, and pre-ART HIV
RNA were higher among the chronic HBV (HR 6, p = 0.009) and HBcAb+
only (HR 4, p = 0.05) groups when compared with never infected. Of 6
deaths among subjects with HBsAg+, 4 were liver-related, but none of
the 4 deaths among the HBcAb+ only were liver-related. In adjusted
models, we found no difference in HIV RNA suppression (p = 0.6) or CD4
recovery (p = 0.08) across the 4 strata.
Conclusions: In this well-characterized, prospectively followed
cohort receiving long-term ART, past or present infection with HBV did not alter
the long-term immunological response to ART as measured by HIV RNA suppression
or CD4 response. However, liver-related deaths were higher in persons with
chronic HBV and non-AIDS mortality was significantly higher in HBcAb+
only subjects.
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