HIV and Hepatitis B Co-infection: Recent Improvements in Short-term Mortality and Effect of Modern Therapy on HIV Outcomes

Radke, Sarah

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March 21, 2019

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Radke, Sarah
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

Hepatitis B virus (HBV) co-infection increases morbidity and mortality among HIV-infected individuals. US treatment guidelines recommend initial antiretroviral therapy (ART) for HIV/HBV co-infected patients include agents active against both HIV and HBV, in particular tenofovir disoproxil fumerate (TDF), based on its efficacy against HBV outcomes. Few studies have examined the comparative effectiveness of TDF-containing ART regimens versus regimens without TDF on HIV outcomes in co-infected patients. To examine the relationship between HBV co-infection and all-cause mortality, we examined data on 3,706 HIV-infected individuals enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) who began ART during three periods: 1998-2001, 2002-2004 and 2005-2008. Time to mortality hazard ratios comparing HBV-infected and HBV-uninfected patients were 2.20 (95% Confidence Interval [CI]: 0.92, 5.23), 2.09 (95% CI: 0.86, 5.07) and 0.96 (95% CI:0.29, 3.16) for patients initiating therapy in 1998-2001, 2002-2004 and 2005-2008 respectively, adjusted for baseline demographic and clinical characteristics. To examine the effect of TDF on HIV virologic and immunologic response, we examined the 212 (6%) HBV co-infected patients in the CNICS cohort. TDF use was associated with superior HIV RNA response during the first 19 months of ART, with an adjusted hazard ratio for time to HIV virologic failure comparing patients without TDF use to patients with TDF use of 2.26 (95% CI: 1.1.8, 4.34). No effect of TDF use on time to HIV virologic failure was seen after patients had consistent HIV RNA suppression for more than 19 months (adjusted hazard ratio=0.44, 95% CI: 0.15, 1.31). We did not observe an effect of TDF use on CD4 count response. Our findings help in identifying the optimal therapeutic management of HIV/HBV co-infected patients, which is not only relevant to individuals living in the US, but is also increasingly relevant to areas of the world where HBV is endemic and modern ART is increasingly available. Efforts to expand the use of agents efficacious against both HIV and HBV are needed, as well as careful monitoring to ensure the positive benefits seen in our studies are also seen for HIV/HBV co-infected patients living in resource limited settings.

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