Impact of Hepatitis D Virus Infection on the Long‐Term Outcomes of Patients with Hepatitis B Virus and HIV Coinfection in the Era of Highly Active Antiretroviral Therapy: A Matched Cohort Study
1Department of Internal Medicine, National Taiwan University Hospital, 2Graduate Institutes of Clinical Medicine, and 3Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
Background.
Triple infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis D virus (HDV) is rare. The influence of HDV infection on the responses to highly active antiretroviral therapy and hepatic complications in patients with HBV‐HIV coinfection remains uncertain.
Methods.Twenty‐six HDV‐infected case patients and 78 HDV‐uninfected matched control subjects were identified between 1 January 1995 and 30 June 2003. Clinical and immunologic outcomes were noted, and HBV and HIV loads and genotypic resistance of HBV to lamivudine were determined.
Results.Case patients had a higher rate of injection drug use (7.7% vs. 1.3%; 
) and lower serum levels of HBV DNA (median level, 4.04 vs. 5.75 log10 copies/mL; 
) than control subjects. During a median observation period of 54.7 months, HDV infection did not have an adverse impact on clinical, virological, or immunologic responses to highly active antiretroviral therapy. However, case patients had higher rates of hepatitis flares (57.7% vs. 23.1%; 
), hyperbilirubinemia (34.6% vs. 14.1%; 
), liver cirrhosis (26.9% vs. 5.1%; 
), hepatic decompensation (23.1% vs. 5.1%; 
), and death (adjusted hazard ratio, 5.41; 95% confidence interval, 1.39–23.85; 
), although these patients had a lower risk of genotypic resistance to lamivudine (0% vs. 57.1%; 
).
Conclusions.HDV infection did not affect clinical, virological, or immunologic responses to highly active antiretroviral therapy in patients with HBV‐HIV coinfection. HDV infection increased risk of hepatitis flares, liver cirrhosis, hepatic decompensation, and death in patients with HBV‐HIV coinfection.
Received 5 September 2006; accepted 5 December 2006; electronically published 20 February 2007.
Cited by
Online publication date: 1-Aug-2008.
CrossRef
Online publication date: 1-Dec-2007.
CrossRef
Online publication date: 1-Sep-2007.
Online publication date: 1-Sep-2007.
CrossRef
-
Presented in part: 13th Conference on Retroviruses and Opportunistic Infections, Denver, Colorado, February 2006 (abstract 838).