Effect of HBV Coinfection on the Clinical Outcome of HIV-Infected Patients in the Highly Active Antiretroviral Therapy (HAART) Era: A Cohort Study

• Main Authors: Kuo-Wei Chiu, 邱國瑋
• Other Authors: Chi-Tai Fang
• Format: Others
• Language: en_US
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/63061572813993341406

碩士 === 國立臺灣大學 === 流行病學研究所 === 98 === Introduction: Due to a shared route of viral transmission (including unprotected sex, blood transfusions, contaminated needles and vertical transmission), hepatitis B virus (HBV) infection is common among human immunodeficiency virus (HIV)-infected patients. Since 1997, the advance of highly active antiretroviral therapy (HAART) has greatly decreased the incidence of acquired immunodeficiency syndrome (AIDS) and prolonged patient survival, which allows a longer time for the development of HBV-associated liver disease. In the HAART era, liver-related deaths (LRD) now account for greater proportion of deaths among HIV-infected patients. Interestingly, lamivudine (3TC), an important component of HAART, can directly inhibit HBV replication, and theoretically, it might decrease the rate of liver-related deaths. Therefore, empirical studies are required to clarify the net results of these dual effects on the prognosis of HIV-HBV coinfected patients in the HAART era. Objectives: This study aimed to investigate the differences in survival between the HBV-HIV coinfected patients with different HBV serological markers. Methods: Six hundred and eleven HIV-infected patients who began the HAART program at the National Taiwan University Hospital (NTUH) or the Taipei Municipal Venereal Disease Control Institution (now Taipei City Hospital, KunMing Branch) (TCHKM) since 1997 were enrolled in this observational cohort study, and 592 patients were analyzed. The patients were divided into three groups: (1) HBsAg-negative; (2) HBsAg-positive, HBeAg-negative, (3) HBsAg-positive, HBeAg-positive. These patients were analyzed as fixed cohorts. To determine the endpoint (all-cause death, AIDS-related death and liver-related death), we used the Taiwan ID number of each patient to perform a cross-reference with the National Death Certificate database. The survival curves of each cohort were analyzed using the mortality rates of AIDS- and liver-related diseases, documented up to Dec 31, 2008. The median follow-up time was 10.25 years. The survival curves were generated using the Kaplan-Meier method, and a log-rank test was used to compare differences between three groups. To adjust for other potential confounding factors, a Cox proportional hazard model was used. Results: The HBsAg prevalence was 21%. Our results revealed that HIV-infected patients with HBV infection had an increased risk for death (including all-cause death, AIDS-related death and liver-related death) in univariate and multivariate analyses. Among the coinfected patients, HBeAg-positive patients demonstrated a higher risk for death (HR>1) but the risk was not statistically significant. Conclusions: Although 90% of the HIV-infected patients received 3TC-containing regimens in this HAART cohort, the HBsAg-positive status remained a significant predictor for LRD. Further studies are required to clarify whether a combination of drugs that effectively inhibit both HIV and HBV is needed for all HIV-HBV-coinfected patients on HAART in areas with a high HBV prevalence.