Clinical

HBV and HIV responses linked in coinfected patients

Last Updated: 2007-09-03 8:30:58 -0400 (Reuters Health)

NEW YORK (Reuters Health) - New research shows that hepatitis B virus early antigen (HBeAg) or HBV surface antigen (HBsAg) seroconversion is associated with a sustained HIV response during antiretroviral therapy.

HBV coinfection is common among HIV-infected patients, but the natural history of chronic hepatitis B in this setting and the impact of highly active antiretroviral therapy (HAART) has on HBeAg and HBsAg seroconversion is unclear, according to the report in the September 1st issue of Clinical Infectious Diseases.

Dr. Patrick Miailhes, from Hopital-Dieu in Lyon, France, and colleagues addressed this topic by analyzing data from 92 coinfected patients. Eighty-two of the patients received antiretroviral therapy, including 79 treated with HAART. Seventy-six patients received lamivudine.

Lamivudine-resistance mutations developed in 28 of the patients given the drug, the report indicates.

During treatment with antiretroviral therapy, anti-HBeAg antibodies developed in 10 of 59 HBeAg-positive patients, HBsAg clearance occurred in 3 of 10 patients, and anti-HBsAg antibodies developed in 2 of 3 patients. Of 23 HBeAg-negative patients, 2 cleared HBsAg and developed anti-HBsAg antibodies.

Seroconversion of HBeAg, HBsAg, or both in combination with undetectable HBV DNA was tied to a sustained HIV response (p = 0.001), shorter duration of antiretroviral therapy, and with more severe disease, the report indicates.

The HBV response was directly related to the increase in CD4+ cell count seen in HAART-treated patients with elevated baseline levels of alanine aminotransferase.

In a related editorial, Dr. Hans L. Tillmann, from the University of Leipzig in Germany, writes that the study yielded some surprises. For instance, a shorter course of antiretroviral therapy was actually linked to higher rates of HBeAg and HBsAg seroconversion. Also, patients with low CD4+ cell counts and those with AIDS had higher conversion rates than patients with earlier HIV disease.

He concludes that further research is needed to understand the basis for these findings. However, he also emphasizes that "preventing HBV infection is better than treating it" and notes that "every HIV-infected patient should be screened for HBV infection and offered vaccination in the instance of negative results for HBV markers."

Clin Infect Dis 2007;45:624-636.