Medline ® Abstract for Reference 10
of 'Treatment of chronic hepatitis B in the HIV-infected patient'
Influence of HIV infection on the response to interferon therapy and the long-term outcome of chronic hepatitis B.
Di Martino V, Thevenot T, Colin JF, Boyer N, Martinot M, Degos F, Coulaud JP, Vilde JL, Vachon F, Degott C, Valla D, Marcellin P
BACKGROUND& AIMS: The outcome of chronic hepatitis B and the efficacy of interferon alfa (IFN-alpha) remain controversial in human immunodeficiency virus (HIV)-positive patients. We analyzed the influence of HIV coinfection on the response to IFN-alpha therapy, long-term virologic status, progression to cirrhosis, and mortality.
METHODS: This was a retrospective follow-up cohort study of 141 consecutive hepatitis B e antigen-positive patients (69 HIV positive) followed up for 45 months.
RESULTS: The short-term response to IFN-alpha therapy was not significantly different in HIV-positive and HIV-negative patients (28% vs. 51%; P = 0.06) but was poorer in cases of low CD4 cell count (P = 0.038). The hepatitis B virus (HBV) reactivation rate was higher in HIV-positive patients (P = 0.033) and was associated with low CD4 cell count. The risk of cirrhosis was higher in HIV-positive patients with a CD4 cell count<200/mm(3) (relative risk [RR], 4.57; P = 0.007), inIFN-alpha-untreated patients (RR, 2.63; P = 0.041), in patients older than 33 years (RR, 4.59; P = 0.008), and in cases of high necroinflammatory score at baseline (RR, 1.27; P = 0.010). Cirrhosis-related death was more frequent in HIV-positive patients with low CD4 cell count at baseline (P = 0.041), in alcohol consumers (P = 0.001), in IFN-alpha-untreated patients (P = 0.052), and in patients with high histology activity index at baseline (P = 0.005).
CONCLUSIONS: HIV coinfection was associated with poorer response to IFN-alpha therapy, more frequent HBV reactivations, and increased incidence of cirrhosis and cirrhosis-related death in cases of low CD4 count. IFN-alpha therapy decreased the incidence of HBV cirrhosis regardless of HIV status or serologic response.
Service d'Hépatologie, INSERM U481 et Centre de Recherche Claude Bernard sur les hépatites virales, Hôpital Beaujon AP-HP, Clichy, France.