There is scant information about the health
consequences of coinfection with chronic hepatitis B (HBV) and HIV.
The study below from Ethiopia found that HBV infection lowers CD4
cells and delays the immune recovery of CD4 cells after initiation of
HIV therapy. However, after HIV therapy is initiated, CD4 cells begin
to recover and after 2 years the negative impact of HBV on immune
recovery is reversed. The authors concluded that their study should
prompt providers to consider early HIV therapy to lessen the impact of
chronic HBV infection on immune function. –Alan Franciscus
Hepatitis B Virus Co-Infection: Yet Another Reason for Early Initiation of Treatment in HIV Infected Individuals
Author(s)
Yared Hailaye, Muluken Dessalegn, Solomon Gebre-Selassie
ABSTRACT
Background:
Hepatitis B virus (HBV) co-infection with HIV is
becoming a major challenge due to shared routes of transmission. The
burden is apparent in regions with widespread use of antiretroviral
treatment, which led to the enhanced emergence of liver-related
diseases and mortality. Though there are conflicting results about the
effect of chronic HBV infection on response to highly active
antiretroviral therapy (HAART) (CD4+ cell count and HIV viral load, HIV
RNA copies/ml), HAART is known to cause immune mediated HBV specific
liver damage after it reconstitutes cell-mediated immunity. The
relationship of different HAART regimes with immune recovery is an area
of research interest.
Objective:
It is in order to determine the changes in immune
recovery during HBV infection in the setting of HAART among HIV
positive individuals attending care and treatment services.
Methods:
Two cohorts of co-infected patients were analyzed from
data of one to seven months retrospectively. The first group (n = 380)
was antiretroviral drug naive and the second cohort (n = 380) was on
HAART for the entire period. The study was conducted in one referral
hospital and six health centers. Data were gathered from 760 patients
using their intake form, their follow-up form and their medical records
supplemented by data from a structured questionnaire. HBV infection
was determined by using HBsAg rapid and confirmatory tests and CD4
cells were enumerated by using laboratory registers and patient cards.
Bivariate and multivariate logistic regressions were done by using SPSS
Version 18 and Epi info Version 3.5.
Results:
Poor immune recovery due to HBV infection was improved
after initiation of HAART. Before the initiation of HAART, the mean
CD4 cell count of HBV infected individuals was lower than that of
non-HBV infected ones, 234/mm3 and 384/mm3, respectively (p < 0.05).
Individuals co-infected with HBV had experienced delayed recovery of
immune cells (CD4 cell count). However, after, on average, more than
two years of therapy, the association is reversed. In addition to HBV
infection, CD4 cell count of patients on chronic HIV care/pre-ART was
decreased by older age, living in rural areas and previous opportunistic
infections.
Conclusion:
HBV infection has different outcomes between pre-ART and
ART-initiated individuals. In the former cohort, HBV infection causes
significant delays in immune recovery which is reversed after
initiation of anti-HIV treatment. HBV co-infection has a significant
and immediate negative effect on CD4 cell counts and immune recovery
before HAART but such effects slowly subside after initiation of the
treatment. As a result, HBV infection is another issue to consider for
swift initiating of HAART for HIV infected individuals in long-term
Labels: HIV/HBV coinfection, treatment strategies