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Predictors of loss of hepatitis B surface antigen in HIV and hepatitis B virus co-infected patients
Presented by Jong Hun Kim, United States.
J.H. Kim1, G. Psevdos2, J. Park3, T. Robinson3, J. Suh2, V. Sharp4
1St.Luke's-Roosevelt Hospital, Department of Medicine, New York, United States, 2St.Luke's-Roosevelt Hospital, Division of Infectious Diseases, New York, United States, 3St.Luke's-Roosevelt Hospital, New York, United States, 4St.Luke's-Roosevelt Hospital, Medical Director, HIV Center, Center for Comprehensive Care, New York, United States
Background: Chronic hepatitis B virus and HIV infection are major public health concerns. Co-infections are associated with increased morbidity and mortality. Factors that influence treatment outcomes are not well defined in this population
Methods: We retrospectively reviewed the medical records of 5681 patients followed at St. Luke’s-Roosevelt Hospital HIV clinic (the Center for Comprehensive Care) in New York City from January 1999 to May 2007. 355 patients co-infected with HBV infection were identified by positive HBV surface antigen (HBSAg). Clinical and laboratory parameters including baseline and follow-up HIV viral loads, CD4+ counts, alanine transaminase (ALT) levels, demographics, duration of antiretroviral therapy (ART) and anti-HBV therapy were analyzed to determine factors associated with loss of HBsAg.
Results: During follow-up period, 283 out of 355 HBV co-infected patients received anti-HBV active ARV, including lamivudine, tenofovir, adefovir or baraclude (79.71%). In the treated group 29/283 (10.3%) lost HBSAg, compared to 7/72 (9.7%) in the group that did not receive any anti-HBV ARV. In univariate analysis, CD4 baseline, CD4 end of follow up, and CD4 gain were associated with loss of HBSAg (P=0.027, 0.013, 0.053, respectively). Using Cox regression analysis with variables P<0.20 in univariate analysis revealed that the following variables were associated with loss of HBSAg: normal ALT (P=0.010, OR=0.165, CI 0.042-0.647), baseline CD4+>500 (P=0.004, OR=25.468, CI 2.820-230.000), and CD4+ gain 71-150 (P=0.047, OR=7.603, CI 1.031-56.080).
Conclusions: In our cohort, use of anti-HBV medication therapy was not associated with loss of HBSAg in HIV/HBV co-infected patients. Positve correlations were observed with CD4 count at baseline, as well as amount of CD4 increase. High CD4 counts at the time of HBV infection and immune restoration through ARV are the most important predictors in successful treatment of HBV in HIV infected patients.
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