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Hepatitis B and HIV: prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort

Konopnicki, Deboraha; Mocroft, Amandab; de Wit, Sa; Antunes, Franciscoc; Ledergerber, Brunod; Katlama, Christinee; Zilmer, Kf; Vella, Stefanog; Kirk, Oleh; Lundgren, Jens Dh; for the EuroSIDA Group

Clinical Science

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: maladies_infecieuses@stpierre-bru.be

© 2005 Lippincott Williams & Wilkins, Inc.