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Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-infected patients in Tanzania

Hawkins, Claudiaa,b; Christian, Beatriceb; Ye, Jitaoc; Nagu, Tumainid; Aris, Ericb,d; Chalamilla, Guerinob,c; Spiegelman, Donnac; Mugusi, Ferdinandd; Mehta, Saurabhe; Fawzi, Wafaieb,c

doi: 10.1097/QAD.0b013e32835cb9c8
Clinical Science

Objectives: To evaluate the prevalence of HIV/hepatitis B virus (HBV) co-infection and relationship between HIV/HBV and health outcomes in a cohort of HIV-infected adults receiving antiretroviral treatment (ART) in urban Tanzania.

Design/methods: Clinical and immunologic responses to ART were compared longitudinally between HIV mono (HIV) and HIV/HBV co-infected (HIV/HBV) adults enrolled between November 2004 and September 2011 at the Management and Development for Health (MDH)-PEPFAR HIV Care and Treatment program in Dar es Salaam, Tanzania.

Results: The prevalence of HIV/HBV co-infection was 6.2% (1079/17 539). Compared to HIV patients, HIV/HBV patients were more likely to be male, younger, and more immunosuppressed at ART initiation. Median ART duration was 18.6 [interquartile range (IQR) 4.9–29.5] and 18.2 (IQR 4.2–27.2) months in HIV and HIV/HBV patients, respectively. In multivariate analyses, a trend towards a higher risk of mortality was observed in HIV/HBV patients {hazard ratio 1.18 [95% confidence interval (CI) 0.98–1.42], P = 0.07} as well as lower CD4+ cell counts throughout recovery (P < 0.01) and higher risk of moderate-to-severe hepatotoxicity (P values < 0.01 for alanine transaminase > 120 and >200 IU/l). There was a higher risk of mortality in HIV/HBV patients vs. HIV patients on non-tenofovir (TDF)-containing ART [hazard ratio 1.28 (95% CI 1.02–1.61), P < 0.03], whereas there was no difference in the risk of mortality observed in HIV/HBV patients vs. HIV patients on TDF-containing ART [hazard ratio 0.70 (95% CI 0.34–1.44), P < 0.33]; interaction P = 0.30.

Conclusions: HBV co-infection significantly impacted ART outcomes in this Tanzanian HIV-infected population. Further research is needed to confirm the potential beneficial effects of TDF on mortality in HIV/HBV co-infected individuals in these settings.

aNorthwestern University Feinberg School of Medicine, Chicago, Illinois, USA

bManagement and Development for Health (MDH), Dar es Salaam, Tanzania

cHarvard School of Public Health, Boston, Massachusetts, USA

dMuhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

eDivision of Nutritional Sciences, Cornell University, Ithaca, New York, USA.

Correspondence to Claudia Hawkins, MD, MPH, DTM&H, Division of Infectious Diseases, Northwestern University, 645 N. Michigan, Suite 900, Chicago, IL 60611, USA. Tel: +1 312 695 4993; fax: +1 312 695 5088; e-mail:

Received 6 August, 2012

Revised 6 November, 2012

Accepted 16 November, 2012

© 2013 Lippincott Williams & Wilkins, Inc.