PLoS ONE (2016-01-01)

Hepatitis B and C Co-Infection in HIV Patients from the TREAT Asia HIV Observational Database: Analysis of Risk Factors and Survival.

  • Marcelo Chen,
  • Wing-Wai Wong,
  • Matthew G Law,
  • Sasisopin Kiertiburanakul,
  • Evy Yunihastuti,
  • Tuti Parwati Merati,
  • Poh Lian Lim,
  • Romanee Chaiwarith,
  • Praphan Phanuphak,
  • Man Po Lee,
  • Nagalingeswaran Kumarasamy,
  • Vonthanak Saphonn,
  • Rossana Ditangco,
  • Benedict L H Sim,
  • Kinh Van Nguyen,
  • Sanjay Pujari,
  • Adeeba Kamarulzaman,
  • Fujie Zhang,
  • Thuy Thanh Pham,
  • Jun Yong Choi,
  • Shinichi Oka,
  • Pacharee Kantipong,
  • Mahiran Mustafa,
  • Winai Ratanasuwan,
  • Nicolas Durier,
  • Yi-Ming Arthur Chen

DOI
https://doi.org/10.1371/journal.pone.0150512
Journal volume & issue
Vol. 11, no. 3
p. e0150512

Abstract

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BACKGROUND:We assessed the effects of hepatitis B (HBV) or hepatitis C (HCV) co-infection on outcomes of antiretroviral therapy (ART) in HIV-infected patients enrolled in the TREAT Asia HIV Observational Database (TAHOD), a multi-center cohort of HIV-infected patients in the Asia-Pacific region. METHODS:Patients testing HBs antigen (Ag) or HCV antibody (Ab) positive within enrollment into TAHOD were considered HBV or HCV co-infected. Factors associated with HBV and/or HCV co-infection were assessed by logistic regression models. Factors associated with post-ART HIV immunological response (CD4 change after six months) and virological response (HIV RNA <400 copies/ml after 12 months) were also determined. Survival was assessed by the Kaplan-Meier method and log rank test. RESULTS:A total of 7,455 subjects were recruited by December 2012. Of patients tested, 591/5656 (10.4%) were HBsAg positive, 794/5215 (15.2%) were HCVAb positive, and 88/4966 (1.8%) were positive for both markers. In multivariate analysis, HCV co-infection, age, route of HIV infection, baseline CD4 count, baseline HIV RNA, and HIV-1 subtype were associated with immunological recovery. Age, route of HIV infection, baseline CD4 count, baseline HIV RNA, ART regimen, prior ART and HIV-1 subtype, but not HBV or HCV co-infection, affected HIV RNA suppression. Risk factors affecting mortality included HCV co-infection, age, CDC stage, baseline CD4 count, baseline HIV RNA and prior mono/dual ART. Shortest survival was seen in subjects who were both HBV- and HCV-positive. CONCLUSION:In this Asian cohort of HIV-infected patients, HCV co-infection, but not HBV co-infection, was associated with lower CD4 cell recovery after ART and increased mortality.