7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)

Abstract

TULBPE13 Poster Exhibition


HBV and HCV co-infection: long term immunological, virological and survival outcomes following cART

Presented by Yi-Ming Arthur Chen (Taiwan, Province of China).

Y.-M.A. Chen1,2,3, Y.-H. Chen3, Y.-T. Lin3, P.-L. Lim4, E. Yunihastuti5, S. Kiertiburanakul6, T. Merati7, R. Chaiwarith8, P. Phanuphak9, P.-C. Li10, N. Kumarasamy11, S. Vonthanak12, R. Ditangco13, C.K. Lee14, K.V. Nguyen15, S. Pujari16, A. Kamarulzaman17, F. Zhang18, T.T. Pham19, J.Y. Choi20, S. Oka21, P. Kantipong22, M. Mustafa23, W. Ratanasuwan24, M. Law25, N. Durier26


1Department of Microbiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Province of China, 2Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, Kaohsiung, Taiwan, Province of China, 3AIDS Prevention and Research Center and Taipei Veteran's General Hospital, National Yang-Ming University, Taipei, Taiwan, Province of China, 4Tan Tock Seng Hospital, Singapore, Singapore, 5Working Group on AIDS Faculty of Medicine, University of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia, 6Faculty of Medicine Ramathibodi Hospital , Mahidol University, Bangkok, Thailand, 7Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia, 8Research Institute for Health Sciences, Chiang Mai, Thailand, 9HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 10Queen Elizabeth Hospital, Hong Kong, China, 11YRG Centre for AIDS Research and Education, Chennai, India, 12National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia, 13Research Institute for Tropical Medicine, Manila, Philippines, 14Hospital Sungai Buloh, Sungai Buloh, Malaysia, 15National Hospital of Tropical Diseases, Honoi, Viet Nam, 16Institute of Infectious Diseases, Pune, India, 17University of Malaya Medical Centre, Kuala Lumpur, Malaysia, 18Beijing Ditan Hospital, Capital Medical University, Beijing, China, 19Bach Mai Hospital, Hanoi, Viet Nam, 20Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea, 21National Center for Global Health and Medicine, Tokyo, Japan, 22Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand, 23Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia, 24Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, 25The Kirby Institute, University of New South Wales, Australia, Australia, 26TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand

Background: The aims of this study were to assess the effects of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on long-term outcomes following antiretroviral therapy (ART) using a multi-center cohort of HIV-1/AIDS patients in the Asia-Pacific region.
Methods: The TREAT Asia HIV Observational Database (TAHOD) consists of 7,455 HIV patients from 22 hospitals located in 11 countries in Asia, with 24,798 total person-years. Patients who stopped ART for >3 months were excluded. Those ever tested positive by antigen or antibody for HBsAg or anti-HCV were regarded as co-infected within the duration of the study. The target HIV viral load (VL) threshold was < 1000 copies/mL.
Results: Hepatitis test results were available for 76% (HBV; 10.45% prevalence) and 70% (HCV; 15.2% prevalence) of TAHOD patients. Compared to mono-infected patients, after ART initiation, patients with HBV (adjusted difference [aDiff], -15.5 cells/mcL, 95% confidence interval [CI] -26.87, -4.99, p=0.011) or HCV (aDiff -37.8 cells/mcL, CI -34.51, -10.25, p< 0.001) had significantly lower CD4 counts. Overall mean CD4 change at 180 days after ART was 122.4 cells/mcL. Patients with HCV had significantly smaller CD4 increases (aDiff -23.9 cells/mcL, CI -36.52, -11.29, p< 0.001); patients with HBV had non-significant but smaller increases (aDiff -10.2 cells/mcL, CI -21.56, 1.22, p=0.08). Patients with HIV subtype CRF01AE had significantly smaller CD4 increases (aDiff -35.5 cells/mcL, CI -66.69, -4.25, p=0.026) compared with HIV subtype B. Median time to reach the target HIV VL was 1.28 years. Patients with HBV co-infection or HCV co-infection had a non-significant but longer time to reach the target HIV VL. In multivariate analysis, patients with HCV co-infection had increased mortality (aHR 1.81, 95% CI 1.20, 2.71, p=0.004). Patients with HBV co-infection or HCV co-infection had significant worse survival curve than those who without HBV and HCV co-infection. Neither HBV nor HCV co-infection was associated with HIV VL.
Conclusion: In this Asia regional HIV cohort, patients with HBV or HCV co-infection had significantly lower CD4 counts, smaller CD4 increases after 180 days of ART. We need to test, identify and initiate HAART early in HBV and HCV co-infected to have a better treatment effect.

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