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Hepatitis B viremia in HIV-coinfected individuals under antiretroviral therapy
Weissmann, Leonardo; Picone, Camila de Melo; Gouvêa, Michele Soares Gomes; Ferreira, Paulo Roberto Abrão; Viana, Mônica Salum Valverde Borsoi; Pinho, João Renato Rebello; Cassenote, Alex Jones Flores; Segurado, Aluísio Cotrim.
  • Weissmann, Leonardo; Universidade de São Paulo. Faculdade de Medicina. Departamento de Doenças Infecciosas e Parasitárias. São Paulo. BR
  • Picone, Camila de Melo; Universidade de São Paulo. Faculdade de Medicina. Departamento de Doenças Infecciosas e Parasitárias. São Paulo. BR
  • Gouvêa, Michele Soares Gomes; Universidade de São Paulo. Faculdade de Medicina. Laboratório de Gastroenterologia e Hepatologia Tropical - LIM-07. São Paulo. BR
  • Ferreira, Paulo Roberto Abrão; Universidade Federal de São Paulo. Departamento de Medicina. São Paulo. BR
  • Viana, Mônica Salum Valverde Borsoi; Hospital do Servidor Público Estadual Francisco Morato de Oliveira. Serviço de Gastroclínica e Hepatologia. São Paulo. BR
  • Pinho, João Renato Rebello; Universidade de São Paulo. Faculdade de Medicina. Laboratório de Gastroenterologia e Hepatologia Tropical - LIM-07. São Paulo. BR
  • Cassenote, Alex Jones Flores; Universidade de São Paulo. Faculdade de Medicina. Departamento de Doenças Infecciosas e Parasitárias. São Paulo. BR
  • Segurado, Aluísio Cotrim; Universidade de São Paulo. Faculdade de Medicina. Departamento de Doenças Infecciosas e Parasitárias. São Paulo. BR
Braz. j. infect. dis ; 23(6): 441-450, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1089314
ABSTRACT
ABSTRACT

Background:

Antiretroviral therapy (ART) has decreased AIDS incidence and mortality, rendering comorbidities, such as hepatitis B more relevant for people living with human immunodeficiency virus (HIV). Since antiretroviral drugs may also inhibit hepatitis B virus (HBV) replication, analyzing the impact of ART on management of hepatitis B in this population is important.

Objective:

To assess HBV viremia among HIV/HBV coinfected individuals on ART and its associated factors.

Method:

For this cross-sectional study, HIV/HBV-coinfected individuals, aged over 18 years, who were on ART for over six months and receiving care at an outpatient clinic in São Paulo were recruited. Sociodemographic characteristics, information about viral exposure, clinical and laboratory data, including evaluation of liver fibrosis were obtained. Plasma HBV DNA was measured by polymerase chain reaction. Viral genome sequencing was conducted for genotyping and identification of drug resistance-conferring mutations if viral load exceeded 900 IU/mL.

Results:

Out of 2,946 patients who attended the clinic in 2015, 83 were eligible and 56 evaluated. Plasma HBV DNA was detected in 16 (28.6%) (95% CI 18.0-41.3%), all on lamivudine and tenofovir treatment. HBV DNA detection was associated with lower education (p = 0.015), higher international normalized ratios (p = 0.045), history of an AIDS-defining illness [OR 3.43 (95% CI 1.10-11.50)], and HBeAg detection [OR 6.60 (95% CI 1.84-23.6)]. In contrast, a last CD4+ count above 500 cells/mm3 in the year prior to inclusion [OR 0.18 (95% CI 0.04-0.71)] and detection of anti-HBe [OR 0.21 (95% CI 0.04-0.99)] were negatively associated. Patients with HBV DNA above 900 IU/mL were infected with subgenotypes A1 (n = 3) and D2 (n = 1), and exhibited viral mutations associated with total resistance to lamivudine and partial resistance to entecavir.

Conclusions:

Despite being on ART, a significant proportion of HIV/HBV-coinfected individuals present HBV viremia. Characterization of factors that are associated with this finding may help professionals provide better management to these patients.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: HIV Infections / Anti-HIV Agents / Viral Load / Antiretroviral Therapy, Highly Active / Coinfection / Hepatitis B Type of study: Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Female / Humans / Male Language: English Journal: Braz. j. infect. dis Journal subject: Communicable Diseases Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital do Servidor Público Estadual Francisco Morato de Oliveira/BR / Universidade Federal de São Paulo/BR / Universidade de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: HIV Infections / Anti-HIV Agents / Viral Load / Antiretroviral Therapy, Highly Active / Coinfection / Hepatitis B Type of study: Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Female / Humans / Male Language: English Journal: Braz. j. infect. dis Journal subject: Communicable Diseases Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital do Servidor Público Estadual Francisco Morato de Oliveira/BR / Universidade Federal de São Paulo/BR / Universidade de São Paulo/BR