TY - JOUR
T1 - Outcomes in HIV/HBV-Coinfected Patients in the Tenofovir Era Are Greatly Affected by Immune Suppression
AU - Huang, Andrew J.
AU - Núñez, Marina
N1 - Publisher Copyright:
© The Author(s) 2014.
PY - 2015/7/25
Y1 - 2015/7/25
N2 - Objectives: HIV-infected patients have higher mortality when coinfected with hepatitis B virus (HBV). With potent highly active antiretroviral therapy (HAART) and the use of tenofovir (TDF), outcomes may improve. Our objective was to determine the clinical and virological outcomes of a HIV/HBV-Coinfected cohort at our center since TDF became available. Methods: We retrospectively studied all HIV/HBV-Coinfected adults followed between 2002 and 2012 for ≥3 months. Outcome measurements included HBV DNA suppression, HBV e-antigen (HBeAg) and HBV surface antigen (HBsAg) clearance, cirrhosis diagnosis, development of liver complications, and overall and liver-related mortality. Predicting factors were assessed with log-rank test and logistic regression. Results: Median time to follow-up of the 99 patients included was 5 years. Undetectable HBV DNA and HBsAg loss were achieved by 65% and 18%, respectively. Overall and liver-related mortality rates were 4.58 and 0.91 per 100 person-years, respectively. Most patients died of causes unrelated to the liver. Four patients died from hepatocellular carcinoma (HCC) and one, hepatitis C virus (HCV) coinfected, from liver failure. Higher CD4 counts at last follow-up were associated with HBV suppression (odds ratio [OR] 1.004, 95% confidence interval [CI] 1.001- 1.006, P .007), HBeAg loss (OR 1.003, 95% CI 1-1.005, P .02), HBsAg loss (CD4 count <700 cells/mm3, OR 3.80, 95% CI 1.06-13.58, P .04), and survival (OR .994, 95% CI 0.990-0.997, P > .0001). HCV coinfection was associated with higher overall mortality (OR 7.74, 95% CI 1.47-40.81, P .02). Conclusion: Mortality was high and most often unrelated to liver disease in this HIV/HBV-Coinfected cohort treated predominantly with TDF-containing HAART. Optimal CD4 counts predicted survival and the achievement of HBV virological end points. Tenofovir prevented liver decompensation but not HCC, which was the predominant cause of liver death.
AB - Objectives: HIV-infected patients have higher mortality when coinfected with hepatitis B virus (HBV). With potent highly active antiretroviral therapy (HAART) and the use of tenofovir (TDF), outcomes may improve. Our objective was to determine the clinical and virological outcomes of a HIV/HBV-Coinfected cohort at our center since TDF became available. Methods: We retrospectively studied all HIV/HBV-Coinfected adults followed between 2002 and 2012 for ≥3 months. Outcome measurements included HBV DNA suppression, HBV e-antigen (HBeAg) and HBV surface antigen (HBsAg) clearance, cirrhosis diagnosis, development of liver complications, and overall and liver-related mortality. Predicting factors were assessed with log-rank test and logistic regression. Results: Median time to follow-up of the 99 patients included was 5 years. Undetectable HBV DNA and HBsAg loss were achieved by 65% and 18%, respectively. Overall and liver-related mortality rates were 4.58 and 0.91 per 100 person-years, respectively. Most patients died of causes unrelated to the liver. Four patients died from hepatocellular carcinoma (HCC) and one, hepatitis C virus (HCV) coinfected, from liver failure. Higher CD4 counts at last follow-up were associated with HBV suppression (odds ratio [OR] 1.004, 95% confidence interval [CI] 1.001- 1.006, P .007), HBeAg loss (OR 1.003, 95% CI 1-1.005, P .02), HBsAg loss (CD4 count <700 cells/mm3, OR 3.80, 95% CI 1.06-13.58, P .04), and survival (OR .994, 95% CI 0.990-0.997, P > .0001). HCV coinfection was associated with higher overall mortality (OR 7.74, 95% CI 1.47-40.81, P .02). Conclusion: Mortality was high and most often unrelated to liver disease in this HIV/HBV-Coinfected cohort treated predominantly with TDF-containing HAART. Optimal CD4 counts predicted survival and the achievement of HBV virological end points. Tenofovir prevented liver decompensation but not HCC, which was the predominant cause of liver death.
KW - chronic hepatitis B
KW - HIV infection
KW - outcomes
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U2 - 10.1177/2325957415586258
DO - 10.1177/2325957415586258
M3 - Article
C2 - 25999329
AN - SCOPUS:84937711175
SN - 2325-9574
VL - 14
SP - 360
EP - 368
JO - Journal of the International Association of Providers of AIDS Care
JF - Journal of the International Association of Providers of AIDS Care
IS - 4
ER -