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1 September 2007

Volume 45, Number 5
Clinical Infectious Diseases 2007;45:624–632
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4505-0016$15.00
DOI: 10.1086/520752
HIV/AIDS MAJOR ARTICLE

Impact of Highly Active Antiretroviral Therapy (HAART) on the Natural History of Hepatitis B Virus (HBV) and HIV Coinfection: Relationship between Prolonged Efficacy of HAART and HBV Surface and Early Antigen Seroconversion

Patrick Miailhes,1,3,4

Mary‐Anne Trabaud,2,3

Pierre Pradat,1,3,4

Bertrand Lebouché,1,3,4

Michèle Chevallier,5

Philippe Chevallier,2,3

Fabien Zoulim,1,3,4 and

Christian Trepo1,3,4

1Hôtel‐Dieu, Service d’Hépatologie et de Gastroentérologie, and 2Hôpital de la Croix‐Rousse, Laboratoire de Virologie, Hospices Civils de Lyon, 3INSERM U871, 4Université Lyon 1, and 5Laboratoire Marcel Mérieux, Lyon, France

Background.Coinfection with hepatitis B virus (HBV) in human immunodeficiency virus (HIV)–infected patients is common. However, little is known about the natural history of chronic hepatitis B in HIV‐infected populations, especially the impact of highly active antiretroviral therapy (HAART) on the outcome of HBV early antigen (HBeAg) and HBV surface antigen (HBsAg) status.

Methods.The characteristics of 92 patients coinfected with HIV and HBV were retrospectively assessed before and after HAART and lamivudine treatment to determine the impact of treatment on chronic hepatitis B and factors associated with HBeAg and/or HBsAg seroconversion.

Results.During follow‐up, 82 patients received antiretroviral therapy, 79 of whom received HAART. Twenty‐eight of the 76 patients who were administered lamivudine therapy developed lamivudine resistance mutations. While receiving antiretroviral therapy, 10 of 59 HBeAg–positive patients developed antibody to HBeAg, 3 of 10 cleared HBsAg, and 2 of 3 developed antibody to HBsAg. Two of 23 HBeAg‐negative patients cleared HBsAg and developed antibody to HBsAg. HBeAg and/or HBsAg seroconversion combined with an undetectable HBV DNA level (i.e., an HBV response) correlated with a sustained HIV response ( ), shorter duration of antiretroviral therapy ( ), and more‐severe disease, as evaluated by Centers for Disease Control and Prevention staging (for stage B vs. stage A, ; for stage C vs. stage A, ). For patients with elevated baseline alanine aminotransferase levels, the HBV response correlated significantly with a greater increase in CD4 cell count while receiving HAART.

Conclusions.In HIV‐HBV–coinfected patients, HBV response correlated with a sustained HIV response to antiretroviral therapy, usually HAART including lamivudine.

Received 30 December 2006; accepted 1 April 2007; electronically published 30 July 2007.

  • (See the article by Gaglio et al. on pages 618–23 and the editorial commentary by Tillman on pages 633–6)

Reprints or correspondence: Dr. Patrick Miailhes, Service d’Hépatologie et de Gastroentérologie, Hôtel‐Dieu, 1 Place de l’Hôpital, 69288 Lyon Cedex 02, France ().

Cited by

Megan Crane, Gail Matthews, Sharon R Lewin. (2008) Hepatitis virus immune restoration disease of the liver. Current Opinion in HIV and AIDS 3:4, 446-452
Online publication date: 1-Aug-2008.
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Reto Nüesch, Jintanat Ananworanich, Preeyaporn Srasuebkul, Ploenchan Chetchotisakd, Wisit Prasithsirikul, Wirat Klinbuayam, Apicha Mahanontharit, Thidarat Jupimai, Kiat Ruxrungtham, Bernard Hirschel. (2008) Interruptions of tenofovir/emtricitabine-based antiretroviral therapy in patients with HIV/hepatitis B virus co-infection. AIDS 22:1, 152-154
Online publication date: 1-Feb-2008.
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Hans L. Tillmann. (2007) Editorial Commentary: Screening for and Treating Hepatitis B Virus in Patients with HIV Infection. Clinical Infectious Diseases 45:5, 633-636
Online publication date: 1-Sep-2007.
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