Risk Of AIDS Higher With Hep B Infection

HIV-positive members of the US military starting antiretroviral therapy (ART) with chronic or resolved hepatitis B virus (HBV) infection had a higher risk of AIDS or death than did cohort members without HBV. In contrast, people with chronic HBV gained CD4 cells faster after starting ART than did people without HBV.

Although HBV coinfection is common with HIV infection because the two viruses share transmission routes, much remains unknown about the potential impact of HBV on clinical outcomes in antiretroviral-treated people. To address that question, the Infectious Disease Clinical Research Program HIV Working Group analyzed ART responses in members of the US Military HIV Natural History Study.

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Researchers divided the cohort into four groups, 1505 HBV-negative people (66%), 518 (23%) with resolved HBV, 139 (6%) with isolated hepatitis B core antigen, and 131 (6%) with chronic HBV infection. The groups did not differ significantly in HIV suppression or treatment failure 6 months or 1 year after starting ART.

During the first 4 to 12 years of ART, people with chronic HBV gained significantly more CD4 cells than people without HBV infection. Despite that advantage, people with chronic HBV infection had a 68% higher risk of AIDS or death than did HBV-negative people (hazard ratio 1.68, 95% confidence interval 1.05 to 2.68), and people with resolved HBV infection had a 61% higher risk of AIDS or death (hazard ratio 1.61, 95% confidence interval 1.15 to 2.25).

The researchers propose that “CD4 cell count reconstitution after [ART initiation] and the risk of an AIDS event or death after [ART initiation] may be associated with hepatitis B status.”