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. Hawkins1,2, B. Christian2, J. Ye3, T. Nagu4, E. Aris2,4, G. Chalamilla2,3, D. Spiegelman3, F. Mugusi4, S. Mehta5, W. Fawzi2,3
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.
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