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Characterization of HIV–HBV coinfection in a multinational HIV-infected cohort

Objective:To understand the HIV–hepatitis B virus (HBV) epidemic from a global perspective by clinically and virologically characterizing these viruses at the time of antiretroviral therapy (ART) initiation in a multinational cohort. Methods and design:HIV-infected patients enrolled in two international studies were classified as HIV–HBV coinfected or HIV monoinfected prior to ART. HIV–HBV coinfected patients were tested for HBV characteristics, hepatitis D virus (HDV), a novel noninvasive marker of liver disease, and drug-resistant HBV. Comparisons between discrete covariates used &khgr;2 or Fisher's exact tests (and Jonchkheere–Terpstra for trend tests), whereas continuous covariates were compared using Wilcoxon Rank-Sum Test. Results:Of the 2105 HIV-infected patients from 11 countries, the median age was 34 years and 63% were black. The 115 HIV–HBV coinfected patients had significantly higher alanine aminotransferase and aspartate aminotransferase values, lower BMI, and lower CD4+ T-cell counts than HIV monoinfected patients (median 159 and 137 cells/&mgr;l, respectively, P = 0.04). In the coinfected patients, 49.6% had HBeAg-negative HBV, 60.2% had genotype A HBV, and 13% were HDV positive. Of the HBeAg-negative patients, 66% had HBV DNA 2000 IU/ml or less compared to 5.2% of the HBeAg-positive individuals. Drug-resistant HBV was not detected. Conclusion:Screening for HBV in HIV-infected patients in resource-limited settings is important because it is associated with lower CD4+ T-cell counts. In settings in which HBV DNA is not available, HBeAg may be useful to assess the need for HBV treatment. Screening for drug-resistant HBV is not needed prior to starting ART in settings in which this study was conducted.