AIDS 2012 Abstract - Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-positive patients in urban Tanzania

MOAB0101 - Oral Abstract Session

Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-positive patients in urban Tanzania

Presented by Claudia Hawkins (United States).

C. Hawkins^1,2, B. Christian², J. Ye³, T. Nagu⁴, E. Aris^2,4, G. Chalamilla^2,3, D. Spiegelman³, F. Mugusi⁴, S. Mehta⁵, W. Fawzi^2,3

¹Northwestern University, Infectious Diseases, Chicago, United States, ²Management and Development for Health, Dar es Salaam, United Republic of Tanzania, ³Harvard School of Public Health, Boston, United States, ⁴Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania, ⁵Cornell University, New York, United States

Background: The effect of chronic hepatitis B (HBV) on HIV outcomes is relatively unknown in sub-Saharan Africa (SSA) where a high burden of HIV-HBV co-infection exists.
Methods: Clinical and immunologic outcomes in response to ART were compared longitudinally between HIV mono- (HIV+) and HIV-HBV co-infected (HIV&HBV+) adults enrolled between November 2004-December 2010 at 18 Management and Development for Health (MDH)-PEPFAR supported HIV clinics in Tanzania. Inclusion criteria were: tested ≥ x1 for HbsAg (DIMA), age ≥15, no prior ART.
Results: The prevalence of HBV was 837/13,107 (6.4%).Compared to HIV+ patients, HIV&HBV+ patients were more likely to be male, older, have lower median CD4+ cell counts, and higher ALT's (p values < 0.05) prior to ART initiation. Mean follow up time on ART was 9.8 (SD 7.8) and 10.1 (SD 7.5) months in HIV&HBV+ and HIV+ patients respectively. In multivariate analyses, there were no significant differences in overall mortality [HR 1.17 (95% CI 0.87,1.33); p=0.52] between HIV&HBV+ and HIV+ patients. CD4+ count response also did not significantly differ between the 2 patient groups (p=0.11). HIV&HBV+ patients had a significantly higher risk of ALT>120IU/L [38/813 (4.7%) vs. 303/12,136 (2.5%); HR 1.76 (1.25, 2.49), p< 0.01] and ALT>200IU/l [20/831 (2.4%) vs. 102/12,236 (0.8%); HR 2.74, (1.66, 4.05), p < 0.01]. HBV+ vs. negative status was associated with a significantly lower mortality among patients on tenofovir (TDF) [HR 0.40 (95% CI -0.19-0.85; p < 0.02)]; but higher mortality among patients on ART not containing TDF [HR 1.70 (95% CI -1.34-2.15; p < 0.01)]; [interaction p-value (< 0.01)].
Conclusions: Co-infection with HBV did not significantly impact mortality or immunologic outcomes in HIV-infected patients on ART in this SSA setting. However, routine monitoring of ALT levels after ART initiation in co-infected individuals is recommended. TDF should be included in initial ART for HIV&HBV co-infected individuals, given the significant mortality benefit observed.