Higher Mortality Despite Early Antiretroviral Therapy in Human Immunodeficiency Virus and Hepatitis B Virus (HBV)-Coinfected Patients With High HBV Replication. : Clin Infect Dis

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Kouame, Menan Gerard | Boyd, A. | Moh, Raoul | Badje, Anani Dodzi | Gabillard, Delphine | Ouattara, Eric | N'Takpe, Jean-Baptiste | Emieme, A. | Maylin, S. | Chekaraou, M. A. | Eholie, Serge Paul | Zoulim, F. | Lacombe, K. | Anglaret, Xavier | Danel, Christine

Edité par CCSD ; Oxford University Press (OUP) -

International audience. Background: In HIV-infected patients, hepatitis B virus (HBV)-coinfection increases the risk of disease progression. Tenofovir+emtricitabine/lamivudine (TDF/XTC)-based antiretroviral therapy (ART), which suppresses HIV and HBV replication, has the potential for decreasing this risk. Here, we analyze the association between HBV replication, early-ART, and mortality in West-African adults. Methods: The Temprano randomized-control trial assessed the benefits of immediately initiating versus deferring ART in HIV-infected adults with high CD4 counts. After trial completion, participants continued follow-up in a post-trial phase. We analyzed the association between HBV-status, immediate-ART, and mortality over the entire trial and post-trial follow-up using multivariable Cox proportional hazards regression. Results: 2052 HIV-infected adults (median baseline CD4=464/mm3) were followed for 9394 person-years. At baseline, 1862 (91%) were HIV-monoinfected and 190 (9%) HIV-HBV-coinfected. Of the latter, 135 (71%) had plasma HBV-DNA <2000 IU/ml and 55 (29%) HBV-DNA >/=2000 IU/ml. The 60-month probability of death was 11.8% (95%CI=5.4-24.5) in coinfected patients with HBV-DNA >/=2000 IU/ml, 4.4% (95%CI=1.9-10.4) in coinfected patients with HBV-DNA <2000 IU/ml and 4.2% (95%CI=3.3-5.4) in HIV-monoinfected patients. Adjusting for ART-strategy (immediate vs. deferred), the hazard ratio of death was 2.74 (95%CI=1.26-5.97) in coinfected patients with HBV-DNA >/=2000 IU/ml and 0.90 (95%CI=0.36-2.24) in coinfected patients with HBV-DNA <2000 IU/ml compared to HIV monoinfected patients. There was no interaction between ART-strategy and HBV-status for mortality. Conclusion: African HIV-HBV coinfected adults with high HBV replication remain at heightened risk of mortality in the early-ART era. Further studies are needed to assess interventions combined with early-ART to decrease mortality in this population.

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