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Impact of viral hepatitis co-infection on response to antiretroviral therapy and HIV disease progression in the HIV-NAT cohort

Law, W Phillipa,b; Duncombe, Chris Ja,b; Mahanontharit, Apichab; Boyd, Mark Aa,b; Ruxrungtham, Kiatb,d; Lange, Joep MAb,c; Phanuphak, Praphanb,d; Cooper, David Aa,b; Dore, Gregory Ja

Clinical Science

Objective: To examine the impact of viral hepatitis co-infection on HIV disease outcomes following commencement of combination antiretroviral therapy in a developing country setting.

Methods: HIV RNA suppression, CD4 cell count recovery, and HIV disease progression were examined within a cohort of Thai HIV-infected patients enrolled in eight HIV-NAT randomized controlled trials of antiretroviral therapy (n = 692). Hepatitis B virus (HBV) and hepatitis C virus (HCV) testing was performed on stored serum.

Results: Mean age was 32.3 years, 52% were male, 11% had CDC category C HIV disease at baseline, and 22% had received prior antiretroviral therapy. Prevalence of HBV, HCV and HBV/HCV co-infection was 8.7, 7.2 and 0.4%, respectively. Median HIV RNA reductions (log10 copies/ml) were approximately 1.5 for HIV, HIV-HBV, HIV-HCV subgroups from week 4 up to week 48. Mean increases in CD4 cell count were significantly lower among HIV-HBV and HIV-HCV subgroups at week 4 (HIV, 62 × 106 cells/l; HIV-HBV, 29 × 106 cells/l; HIV-HCV, 33 × 106 cells/l), however, by week 48 CD4 cell increases were similar (HIV, 115 × 106 cells/l; HIV-HBV, 113 × 106 cells/l; HIV-HCV, 97 × 106 cells/l). Cox regression analyses showed that HIV-HBV or HIV-HCV co-infection were not associated with a CD4 cell count increase of 100 × 106 cells/l over 48 weeks. Estimated progression to AIDS event or death at week 48 was 3.3% (95% confidence interval, 2.0–5.1%) for HIV, 6.7% (2.5–14.6%) for HIV-HBV, and 8.0% (2.2–20.5%) for HIV-HCV subgroups (P > 0.05).

Conclusions: An early delayed CD4 count recovery among HIV/viral hepatitis co-infected patients was not sustained, and was not associated with increased HIV disease progression.

From the aNational Centre in HIV Epidemiology and Clinical Research (NCHECR), The University of New South Wales, Sydney, Australia, the bHIV-Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand, the cInternational Antiviral Therapy Evaluation Centre (IATEC), University of Amsterdam, Amsterdam, The Netherlands and the dFaculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Correspondence to Dr Gregory J. Dore, National Centre in HIV Epidemiology and Clinical Research, Level 2, 376 Victoria Street, Darlinghurst, Sydney 2010, Australia.

Tel: +61 2 9385 0900; fax: +61 2 9385 0920; e-mail: gdore@nchecr.unsw.edu.au

Received: 12 December 2003; revised: 24 February 2004; accepted: 16 March 2004.

© 2004 Lippincott Williams & Wilkins, Inc.