Background: Whether hepatitis B (HBV) coinfection affects outcome in HIV-1-infected patients remains unclear.
Objective: To assess the prevalence of HBV (assessed as HBsAg) coinfection and its possible impact on progression to AIDS, all-cause deaths, liver-related deaths and response to highly active antiretroviral therapy (HAART) in the EuroSIDA cohort.
Methods: Data on 9802 patients in 72 European HIV centres were analysed. Incidence rates of AIDS, global mortality and liver-related mortality, time to 25% CD4 cell count increase and time to viral load < 400 copies/ml after starting HAART were calculated and compared between HBsAg-positive and HBsAg-negative patients.
Results: HBsAg was found in 498 (8.7%) patients. The incidence of new AIDS diagnosis was similar in HBsAg-positive and HBsAg-negative patients (3.3 and 3.4/100 person-years, respectively) even after adjustment for potential confounders: the incidence rate ratio (IRR) was 0.94 [95% confidence interval (CI), 0.74–1.19; P = 0.61]. The incidences of all-cause and liver-related mortalities were significantly higher in HBsAg-positive subjects (3.7 and 0.7/100 person-years, respectively) compared with HBsAg-negative subjects (2.6 and 0.2/100 person-years, respectively). The adjusted IRR values were 1.53 for global (95% CI, 1.23–1.90; P = 0.0001) and 3.58 for liver-related (95% CI, 2.09–6.16; P < 0.0001) mortality. HBsAg status did not influence viral or immunological responses among the 1679 patients starting HAART.
Conclusions: The prevalence of HBV coinfection was 9% in the EuroSIDA cohort. Chronic HBV infection significantly increased liver-related mortality in HIV-1-infected patients but did not impact on progression to AIDS or on viral and immunological responses to HAART.
From the aSaint-Pierre University Hospital, Brussels, Belgium
bRoyal Free and University College Medical School, London, UK
cHospital Santa Maria, Lisbon, Portugal
dUniversity Hospital, Zurich, Switzerland
ePitié-Salpêtrière Hospital, Paris, France
fTallinn Merimetsa Hospital, Tallinn, Estonia
gIstituto Superiore di Sanita, Rome, Italy
hHvidovre Hospital, Hvidovre, Denmark.
Received 17 August, 2004
Revised 8 December, 2004
Accepted 20 December, 2004
Requests for reprints to: Dr D. Konopnicki, Division of Infectious Diseases, Saint-Pierre University Hospital, 322 rue Haute, 1000 Brussels, Belgium. E-mail: firstname.lastname@example.org