1. Higher risk of mortality in HIV-HBV co-infected patients from sub-Saharan Africa is observed at lower CD4 + cell counts.
- Author
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Kouamé GM, Gabillard D, Moh R, Badje A, Ntakpé JB, Emième A, Maylin S, Toni TD, Ménan H, Zoulim F, Danel C, Anglaret X, Eholié S, Lacombe K, and Boyd A
- Subjects
- Africa South of the Sahara epidemiology, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, DNA, Viral, Hepatitis B Surface Antigens, Hepatitis B virus genetics, Humans, Coinfection epidemiology, HIV Infections complications, HIV Infections drug therapy, HIV Infections epidemiology, HIV Seropositivity, Hepatitis B complications, Hepatitis B epidemiology
- Abstract
Background: Hepatitis B virus (HBV) co-infection in human immunodeficiency virus (HIV)-positive individuals increases the risk of overall mortality, especially when HBV DNA levels are high. The role of CD4
+ cell counts in this association is poorly defined. We aimed to determine whether HIV-HBV co-infection influences changes in CD4+ cell count before and during antiretroviral therapy and whether it affects mortality risk at levels of CD4+ ., Methods: 2052 HIV-positive participants from Côte d'Ivoire in a randomized-control trial assessing early or deferred ART were included. HBV-status was determined by hepatitis B surface antigen (HBsAg). Changes in CD4+ cell levels were estimated using a mixed-effect linear model. The incidence rates of all-cause mortality were estimated at CD4+ counts ≤350, 351-500, >500/mm3 and were compared between HBV-status groups as incidence rate ratios (IRR)., Results: At baseline, 190 (9%) were HBsAg-positive [135 (71%) with HBV DNA <2000 IU/mL, 55 (29%) ≥2000 IU/mL]. Follow-up was a median 58 months (IQR = 40-69). Between co-infection groups, there were no differences in CD4+ decline before ART initiation and no differences in CD4+ increase after ART initiation. After adjusting for sex, age, baseline HIV RNA level, and early/deferred ART arm, mortality rates were not significantly different between HBsAg-positive versus HBsAg-negative participants across strata of CD4+ levels. However, HBsAg-positive individuals with HBV-DNA ≥2000 IU/mL versus HBsAg-negative individuals had increased mortality rates at ≤350/mm3 (adjusted-IRR = 3.82, 95% CI = 1.11-9.70) and 351-500/mm3 (adjusted-IRR = 4.37, 95% CI = 0.98-13.02), but not >500/mm3 (adjusted-IRR = 1.07, 95% CI = 0.01-4.91)., Conclusion: Despite no effect of HBV-infection on CD4+ levels, HIV-HBV co-infected individuals with high HBV replication are at higher risk of mortality when CD4+ is <500/mm3 .- Published
- 2021
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