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HIV Outcomes in Hepatitis B Virus Coinfected Individuals on HAART

Chun, Helen M. MD*; Mesner, Octavio MS*; Thio, Chloe L. MD; Bebu, Ionut PhD*; Macalino, Grace PhD*; Agan, Brian K. MD*; Bradley, William P. MS*; Malia, Jennifer PhD*,‡; Peel, Sheila A. PhD*,‡; Jagodzinski, Linda L. PhD*,‡; Weintrob, Amy C. MD*,§; Ganesan, Anuradha MD*,§; Bavaro, Mary MD*,‖; Maguire, Jason D. MD*,¶; Landrum, Michael L. MD#the Infectious Disease Clinical Research Program HIV Working Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2014 - Volume 66 - Issue 2 - p 197–205
doi: 10.1097/QAI.0000000000000142
Epidemiology and Prevention

Background: Understanding the impact of hepatitis B virus (HBV) coinfection on HIV outcomes in the highly active antiretroviral therapy (HAART) era continues to be a critical priority given the high prevalence of coinfection and the potential for impaired immunologic, virologic, and clinical recovery.

Methods: Participants from the US Military HIV Natural History Study with an HIV diagnosis on HAART and serologically confirmed HBV infection status at HAART initiation (HI) were classified into 4 HBV infection (HB) groups. HIV virologic, immunologic, and clinical outcomes were evaluated by HB status.

Results: Of 2536 HIV-positive HAART recipients, with HBV testing results available to determine HB status in the HI window, HB status at HI was classified as HB negative (n = 1505; 66%), resolved HB (n = 518; 23%), isolated hepatitis B core antigen (n = 139; 6%), or chronic HB (n = 131; 6%). HIV virologic suppression and failure at 6 months or 1 year were not significantly different by HB status. A significantly faster rate of increase in CD4 cell count during the period between 4 and 12 years was observed for chronic HB relative to HB negative. Chronic and resolved HB were associated with an increased risk of AIDS/death compared with HB-negative individuals (chronic HB—hazard ratio = 1.68, 95% confidence interval: 1.05 to 2.68; resolved HB—hazard ratio = 1.61, 95% confidence interval: 1.15 to 2.25).

Conclusions: HB status did not have a significant impact on HIV virologic outcomes, however, CD4 cell count reconstitution after HI and the risk of an AIDS event or death after HI may be associated with HB status.

*Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD;

Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD;

US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD;

§Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD;

Infectious Disease Clinic, Naval Medical Center, San Diego, CA;

Division of Infectious Diseases, Naval Medical Center, Portsmouth, VA; and

#Bellin Health Green Bay and Clinica Hispana, Green Bay, WI.

Correspondence to: Helen M. Chun, MD, Infectious Disease Clinical Research Program, 11300 Rockville Pike, Suite 600, North Bethesda, MD 20852 (e-mail: vgi2@cdc.gov).

Supported by the Infectious Diseases Clinical Research Program (IDCRP, www.idcrp.org), a DoD program executed through Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072. The IDCRP reviewed the study design, collected the data, and provided salary support to investigators (M.L.L., A.C.W., A.G., and B.K.A.). The analyses, conclusions, and decision to submit the article are the independent work and decision of the authors.

The other authors have no funding or conflicts of interest to disclose.

The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the NIH or the Department of Health and Human Services, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government.

Received February 28, 2014

Accepted February 28, 2014

© 2014 by Lippincott Williams & Wilkins