Hepatitis B and C co-infection among HIV-infected adults while on antiretroviral treatment: long-term survival, CD4 cell count recovery and antiretroviral toxicity in Cambodia.
Johan van Griensven,Lay Phirum,Kimcheng Choun,Sopheak Thai,Anja De Weggheleire,Lutgarde Lynen +5 more
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TLDR
HBV and HCV co- Infection was associated with worse ART outcomes and the effect of early ART initiation and providing effective treatment for hepatitis co-infection should be explored.Abstract:
Background
Despite the high burden, there is a dearth of (long-term) outcome data of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infected patients receiving antiretroviral treatment (ART) in a clinical setting in resource-constrained settings, particularly from Asia.
Methods
We conducted a retrospective cohort study including all adults initiating standard ART (non-tenofovir-based) between 03/2003 and 09/2012. HBV infection was diagnosed by HBV surface antigen detection. HCV diagnosis relied on antibody detection. The independent effect of HBV and HCV on long-term (≥5 years) ART response in terms of mortality (using Cox regression), severe livertoxicity (using logistic regression) and CD4 count increase (using mixed-effects modelling) was determined.
Results
A total of 3089 adults were included (median age: 35 years (interquartile range 30–41); 46% male), of whom 341 (11.0%) were co-infected with HBV and 163 (5.3%) with HCV. Over a median ART follow-up time of 4.3 years, 240 individuals died. Mortality was 1.6 higher for HBV co-infection in adjusted analysis (P = 0.010). After the first year of ART, the independent mortality risk was 3-fold increased in HCV co-infection (P = 0.002). A total of 180 (5.8%) individuals discontinued efavirenz or nevirapine due to severe livertoxicity, with an independently increased risk for HBV (hazard ratio (HR) 2.3; P<0.001) and HCV (HR 2.8; P<0.001). CD4 recovery was lower in both HBV and HCV co-infection but only statistically significant for HBV (P<0.001).
Discussion
HBV and HCV co-infection was associated with worse ART outcomes. The effect of early ART initiation and providing effective treatment for hepatitis co-infection should be explored.read more
Citations
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TL;DR: The expanding implementation of HBV vaccination has been effective in reducing the incidence of liver cancer, especially in countries like China, but further effort is required to tackle the rising prevalence of HCV infection, for which a vaccine is not available.
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Kasha P. Singh,Megan Crane,Jennifer Audsley,Anchalee Avihingsanon,Joe Sasadeusz,Sharon R Lewin +5 more
TL;DR: This paper reviews recent studies examining the natural history and pathogenesis of liver disease and seroconversion in HIV–HBV coinfection in the era of HBV-active antiretroviral therapy and the effects of HIV directly on liver disease.
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TL;DR: The mechanism and risk factors of incomplete immune reconstitution and strategies to intervene in HIV‐1‐infected patients are highlighted.
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Hepatitis B and C Co-Infection in HIV Patients from the TREAT Asia HIV Observational Database: Analysis of Risk Factors and Survival
Marcelo Chen,Marcelo Chen,Wing-Wai Wong,Matthew Law,Sasisopin Kiertiburanakul,Evy Yunihastuti,Tuti Parwati Merati,Poh Lian Lim,Romanee Chaiwarith,Praphan Phanuphak,Man Po Lee,Nagalingeswaran Kumarasamy,Vonthanak Saphonn,Rossana Ditangco,Benedict Lim Heng Sim,Kinh Van Nguyen,Sanjay Pujari,Adeeba Kamarulzaman,Fujie Zhang,Thuy Thanh Pham,Jun Yong Choi,Shinichi Oka,Pacharee Kantipong,Mahiran Mustafa,Winai Ratanasuwan,Nicolas Durier,Yi Ming Arthur Chen +26 more
TL;DR: HIV-infected patients enrolled in the TREAT Asia HIV Observational Database were enrolled in a multi-center cohort of HIV- Infected patients in the Asia-Pacific region, and HCV co-infection, but not HBV co, infection, was associated with lower CD4 cell recovery after ART and increased mortality.
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Slow CD4+ T-Cell Recovery in Human Immunodeficiency Virus/Hepatitis B Virus-Coinfected Patients Initiating Truvada-Based Combination Antiretroviral Therapy in Botswana.
Motswedi Anderson,Simani Gaseitsiwe,Sikhulile Moyo,Kerapetse P. Thami,Terence Mohammed,Terence Mohammed,Ditiro Setlhare,Theresa K. Sebunya,Eleanor A. Powell,Joseph Makhema,Jason T. Blackard,Richard Marlink,Max Essex,Rosemary Musonda +13 more
TL;DR: Screening for Hepatitis B virus screening before cART initiation could help improve HBV/HIV treatment outcomes and help determine treatment options when there is a need to switch regimens.
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