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

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. 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 0.90 (95%CI=0.36-2.24) in coinfected patients with HBV-DNA