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Wang C, Shi Y, Liu Y, Zhou Y, Du J, Hu X, Li W, Li J, Gao Y, Li G. Coinfection of hepatitis B, tuberculosis, and HIV/AIDS in Beijing from 2016 to 2023: a surveillance data analysis. BMC Infect Dis 2025; 25:584. [PMID: 40269753 PMCID: PMC12016106 DOI: 10.1186/s12879-025-10952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 04/09/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Hepatitis B (HB), tuberculosis (TB), HIV infection and AIDS (HIV/AIDS) are the major public health threats in China. The existing domestic research shows significant regional differences in the coinfection of HB, TB, and HIV/AIDS and mainly focused on two diseases. This study aims to analyse the coinfection of HB, TB, and HIV/AIDS patients in Beijing from 2016 to 2023. METHODS We obtained data on cases diagnosed with HB, TB, or HIV/AIDS between 1 January 2016 and 31 December 2023 in Beijing from the National Notifiable Disease Reporting System (NNDRS). After removing duplicate cards with the same disease, we compared the demographic, temporal, and spatial characteristics between coinfections and mono-infections and among coinfections with different diagnostic sequences using chi-squared test. We also explored the risk factors for coinfection by multivariate logistic models. RESULTS Overall, 104,141 cards from 103,595 cases in Beijing were included in this study. The number of cases infected with HIV/AIDS, HB, or TB alone was 20,884 (20.12%), 23,853 (23.03%), and 58,357 (56.33%), respectively. Furthermore, 47 cases (0.05%) were diagnosed with HIV/AIDS and HB, 153 (0.15%) with HB and TB, and 336 (0.32%) with HIV/AIDS and TB. And only five cases were diagnosed with all three diseases. 0.22% HB and 1.58% TB were coinfected among HIV/AIDS patients; 0.64% TB and 0.20% HIV/AIDS were coinfected in HB patients, and 0.26% HB and 0.57% HIV/AIDS in TB patients. Differences in demographic characteristics, residential areas, and diagnosis years were found between coinfected patients and those with a single disease. In contrast, almost no significant difference in characteristics and diagnostic time intervals was found among comorbidity patients with the same diseases but different diagnostic sequences. The multivariate logistic model shown that males were more susceptible to be coinfected (ORs ranged from 1.50 to 27.81). Compared with the cases aged 60 and above, younger TB patients were more likely to be coinfected with HIV/AIDS (OR = 2.76[95%CI:1.59-4.77], 5.36[3.16-9.07]and 2.75[1.62-4.65] for those aged 15-29, 30-44 and 45-59), while younger HB or HIV/AIDS patients were less likely to be coinfected with TB (OR = 0.37[0.18-0.73], 0.34[0.20-0.59], 0.63[0.40-0.98] for younger HB and OR = 0.27[0.15-0.48],0.46[0.26-0.81],0.59[0.33-1.03] for younger HIV/AIDS). Compared with TB patients in urban areas, suburban patients are less likely to be infected with HIV/AIDS (OR = 0.63[0.50-0.79] for inner suburbs and 0.33[0.16-0.72] for outer suburbs). Patients infected with TB or HIV/AIDS living in outer suburbs were more likely to be coinfected with HB (OR = 2.65[1.62-4.34] for TB and OR = 4.04[1.18-13.85] for HIV/AIDS). Patients coinfected with TB and HB had longer diagnostic intervals than those infected with HIV. CONCLUSIONS The incidence of comorbidity of HB, TB, and HIV/AIDS was low and showed a declining trend in Beijing. Among various types of coinfections, HIV/AIDS coinfected with TB has the highest incidence. Males should be considered as the primary target population for preventing coinfections. In addition to promoting the development of information technology and integrating data from multiple sources, it is essential to conduct thematic investigations, enhance education among key populations, and intensify the tracking of close contacts of existing patients to prevent and control the spread of these diseases.
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Affiliation(s)
- Chao Wang
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
- Beijing Academy of Preventive Medicine, Beijing, 100013, China
- Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research On Emerging Infectious Diseases, Beijing, 100013, China
| | - Yunping Shi
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
- Beijing Academy of Preventive Medicine, Beijing, 100013, China
| | - Yang Liu
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
- Beijing Academy of Preventive Medicine, Beijing, 100013, China
| | - Ying Zhou
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
- Beijing Academy of Preventive Medicine, Beijing, 100013, China
| | - Jing Du
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
- Beijing Academy of Preventive Medicine, Beijing, 100013, China
- Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research On Emerging Infectious Diseases, Beijing, 100013, China
| | - Xiao Hu
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
- Beijing Academy of Preventive Medicine, Beijing, 100013, China
| | - Wei Li
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
- Beijing Academy of Preventive Medicine, Beijing, 100013, China
- Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research On Emerging Infectious Diseases, Beijing, 100013, China
| | - Jiaze Li
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
- Beijing Academy of Preventive Medicine, Beijing, 100013, China
| | - Yanlin Gao
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China.
- Beijing Academy of Preventive Medicine, Beijing, 100013, China.
- Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research On Emerging Infectious Diseases, Beijing, 100013, China.
| | - Gang Li
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, 100013, China.
- Beijing Academy of Preventive Medicine, Beijing, 100013, China.
- Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research On Emerging Infectious Diseases, Beijing, 100013, China.
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2
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Mukhatayeva A, Mustafa A, Dzissyuk N, Issanov A, Bayserkin B, Vermund SH, Ali S. Hepatitis B, Hepatitis C, tuberculosis and sexually-transmitted infections among HIV positive patients in Kazakhstan. Sci Rep 2021; 11:13542. [PMID: 34188081 PMCID: PMC8241865 DOI: 10.1038/s41598-021-92688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
In contrast with global trends, HIV prevalence in Kazakhstan and other Central Asian countries has been rising in recent years. In this study, we analyzed hepatitis B (HBV), hepatitis C (HCV), tuberculosis (TB) and sexually-transmitted (STI) co-infections among 500 HIV positive study participants recruited from all regions of Kazakhstan. Among our study participants, 27%, 8%, 2%, and 5% were coinfected with, respectively, HCV, TB, HBV, and STI. A considerable proportion of the study participants was also found with triple or quadruple infections of HCV/TB (12%), TB/STI (0.8%), HCV/STI (2%), HCV/HBV (1%), HBV/TB (0.4%), HBV/STI (0.2%), HBV/HCV/TB (0.4%), HBV/HCV/STI (0.2%), or HCV/TB/STI (0.2%). Strong associations were found of certain age groups, duration of HIV infection, and practices of injection drug use and sexual contact with PLWH, with co-infections of HIV/HCV and HIV/TB. The odds of having death was 4.07 times higher with TB/HIV as compared to other co-infections. Co-occurrence of HIV with HCV, HBV, and TB infections among participants of this study highlights the necessity of regular screening for HCV infection among HIV infected patients, together with implementation of vigilant vaccination protocols against HBV and TB. Additionally, persons who inject drugs especially need to be focused for harm reduction efforts that include opiate substitution therapy, needle or syringe exchange programs, regular screening, and increased availability of ART and direct acting antivirals.
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Affiliation(s)
- Ainur Mukhatayeva
- Department of Biomedical Sciences, Nazarbayev School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Aidana Mustafa
- Department of Biomedical Sciences, Nazarbayev School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Natalya Dzissyuk
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | - Alpamys Issanov
- Department of Biomedical Sciences, Nazarbayev School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Bauyrzhan Bayserkin
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | | | - Syed Ali
- Department of Biomedical Sciences, Nazarbayev School of Medicine, Nazarbayev University, Astana, Kazakhstan.
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3
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Rana U, Driedger M, Sereda P, Pan S, Ding E, Wong A, Walmsley S, Klein M, Kelly D, Loutfy M, Thomas R, Sanche S, Kroch A, Machouf N, Roy-Gagnon MH, Hogg R, Cooper CL. Clinical and demographic predictors of antiretroviral efficacy in HIV-HBV co-infected patients. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:137-148. [PMID: 36341035 PMCID: PMC9608701 DOI: 10.3138/jammi-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/22/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND The clinical and demographic characteristics that predict antiretroviral efficacy among patients co-infected with HIV and hepatitis B virus (HBV) remain poorly defined. We evaluated HIV virological suppression and rebound in a cohort of HIV-HBV co-infected patients initiated on antiretroviral therapy. METHODS A retrospective cohort analysis was performed with Canadian Observation Cohort Collaboration data. Cox proportional hazards models were used to determine the factors associated with time to virological suppression and time to virological rebound. RESULTS HBV status was available for 2,419 participants. A total of 8% were HBV co-infected, of whom 95% achieved virological suppression. After virological suppression, 29% of HIV-HBV co-infected participants experienced HIV virological rebound. HBV co-infection itself did not predict virological suppression or rebound risk. The rate of virological suppression was lower among patients with a history of injection drug use or baseline CD4 cell counts of <199 cells per cubic millimetre. Low baseline HIV RNA and men-who-have-sex-with-men status were significantly associated with a higher rate of virological suppression. Injection drug use and non-White race predicted viral rebound. CONCLUSIONS HBV co-infected HIV patients achieve similar antiretroviral outcomes as those living with HIV mono-infection. Equitable treatment outcomes may be approached by targeting resources to key subpopulations living with HIV-HBV co-infection.
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Affiliation(s)
- Urvi Rana
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Matt Driedger
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Sereda
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Shenyi Pan
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Erin Ding
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Alex Wong
- Regina Qu’Appelle Health Region, Regina, Saskatchewan, Canada
| | | | - Marina Klein
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Deborah Kelly
- Memorial University of Newfoundland, Saint John’s, Newfoundland, Canada
| | - Mona Loutfy
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Rejean Thomas
- Clinique Medicale l’Actuel, Montreal, Quebec, Canada
| | - Stephen Sanche
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Abigail Kroch
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Nima Machouf
- Clinique de Médicine Urbaine du Quartier Latin, Montreal, Quebec, Canada
| | | | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Curtis L Cooper
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Mohareb AM, Menan Kouamé G, Gabassi A, Gabillard D, Moh R, Badje A, Emième A, Maylin S, Ménan H, Hyle EP, Delaugerre C, Danel C, Anglaret X, Lacombe K, Eholié SP, Boyd A. Mortality in relation to hepatitis B virus (HBV) infection status among HIV-HBV co-infected patients in sub-Saharan Africa after immediate initiation of antiretroviral therapy. J Viral Hepat 2021; 28:621-629. [PMID: 33382189 PMCID: PMC7946742 DOI: 10.1111/jvh.13461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022]
Abstract
It is unknown how past and active hepatitis B virus (HBV) infection affect immunorecovery and mortality in people with HIV who initiate tenofovir-based antiretroviral therapy (ART). Using data collected between 2008 and 2015, we studied people with HIV in sub-Saharan Africa initiating immediate ART in the Temprano randomized control trial. We classified participants into HBV groups at ART initiation: hepatitis B surface antigen (HBsAg)-positive with HBV DNA ≥ 2,000 IU/ml; HBsAg-positive with HBV DNA < 2,000 IU/ml; isolated HBcAb-positive; resolved infection (HBsAb-positive/HBcAb-positive); and HBV non-immune/vaccinated (HBcAb-negative). We compared square-root CD4-cell count increases using mixed-effect, non-linear regression adjusted for age, sex, baseline CD4 cell count, and HIV RNA. We compared all-cause mortality using Bayesian parametric survival regression. Among 879 participants, 24 (2.7%) had HBsAg with high HBV DNA, 76 (8.6%) HBsAg with low HBV DNA, 325 (37.0%) isolated anti-HBcAb, 226 (25.7%) resolved HBV infection and 228 (25.9%) HBV non-immune/vaccinated. We found no significant difference in CD4 cell increases between HBV-infection groups after adjustment (p = 0.16). Participants with HBsAg and high HBV DNA had the highest incidence of all-cause mortality (1.9/100 person-years, 95% Credibile Interval [CrI] = 1.0-3.4). By comparison, incidence rates of mortality were reduced by 57% (95%CrI = -79%, -13%), 60% (95%CrI = -82%, -12%) and 66% (95%CrI = -84%, -23%) in those who had isolated anti-HBcAb-positive, resolved HBV infection and HBV non-immune/vaccinated, respectively. In conclusion, individuals with HIV and past HBV infection or isolated anti-HBcAb-positive serology, much like HBV non-immune/vaccinated, experience lower mortality than those with HBsAg and high HBV DNA. Additional HBV-related management would not be necessary for these individuals.
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Affiliation(s)
- Amir M. Mohareb
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Gérard Menan Kouamé
- Programme PAC-CI site ANRS de Côte d’Ivoire, Abidjan, Côte d’Ivoire.,INSERM UMR1219 IDLIC, Bordeaux, France
| | | | | | - Raoul Moh
- Programme PAC-CI site ANRS de Côte d’Ivoire, Abidjan, Côte d’Ivoire.,Service des Maladies Infectieuses et Tropicale, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Anani Badje
- Programme PAC-CI site ANRS de Côte d’Ivoire, Abidjan, Côte d’Ivoire.,Service des Maladies Infectieuses et Tropicale, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Arlette Emième
- Service des Maladies Infectieuses et Tropicale, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Sarah Maylin
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Hervé Ménan
- Laboratoire CeDreS, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Emily P. Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, USA.,Harvard Center for AIDS Research, Boston, USA
| | - Constance Delaugerre
- Laboratoire de Virologie, Hôpital Saint-Louis, AP-HP, Paris, France.,INSERM U944, Institut de Recherche Saint-Louis, Paris, France
| | - Christine Danel
- Programme PAC-CI site ANRS de Côte d’Ivoire, Abidjan, Côte d’Ivoire.,INSERM UMR1219 IDLIC, Bordeaux, France.,University of Bordeaux, France
| | - Xavier Anglaret
- Programme PAC-CI site ANRS de Côte d’Ivoire, Abidjan, Côte d’Ivoire.,INSERM UMR1219 IDLIC, Bordeaux, France.,University of Bordeaux, France
| | - Karine Lacombe
- INSERM, UMR_S1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France.,Service des maladies infectieuses et tropicales, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Serge P. Eholié
- Programme PAC-CI site ANRS de Côte d’Ivoire, Abidjan, Côte d’Ivoire.,Service des Maladies Infectieuses et Tropicale, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Anders Boyd
- INSERM, UMR_S1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France.,Corresponding author: Anders Boyd, MPH, PhD, Stichting HIV Monitoring, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands,
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5
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Malagnino V, Cerva C, Teti E, Campogiani L, Compagno M, Foroghi Biland L, Saderi L, Armenia D, Salpini R, Svicher V, Sotgiu G, Iannetta M, Andreoni M, Sarmati L. Poor CD4/CD8 ratio recovery in HBcAb-positive HIV patients with worse immune status is associated with significantly higher CD8 cell numbers. Sci Rep 2021; 11:3965. [PMID: 33597631 PMCID: PMC7889897 DOI: 10.1038/s41598-021-83616-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Low CD4+ cell count in patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection during combination antiretroviral therapy (cART) has been described; however, notably few studies have investigated coinfected patients positive for antibodies to the HBV c antigen (HBcAb). An observational retrospective study enrolling 190 patients was conducted by grouping patients with respect to HBV status and recording CD4+ T cell counts and percentages (CD4%), CD8+ T cell counts and percentages (CD8%), and the CD4+ to CD8+ T cell ratio (CD4/CD8) at the time of HIV diagnosis, at the start of treatment and at months 1, 2, 3, 4, 5, 6, 12, and 24 after beginning cART. One hundred and twenty patients (63.2%) were negative for previous HBV infection, while 70 (36.8%) were HBcAb-positive. A significant increase in the CD4/CD8 ratio was recorded in HIV monoinfected subjects compared to HBV coinfected patients from months 4 to 12 from the beginning of cART (p value = 0.02 at month 4, p value = 0.005 at month 5, p value = 0.006 at month 6, and p value = 0.008 at month 12). A significant increase in the absolute count of CD8+ T lymphocytes was described from months 2 to 24 from the start of cART in the subgroup of HBV coinfected patients with an AIDS event at the onset of HIV infection. The presence of HBcAb was observed to be associated with reduced CD4/CD8 ratio growth and a significantly higher proportion of subjects with CD4/CD8 < 0.45 in the HIV/HBV coinfected group. A significant increase in the CD8 T cell count was shown up to 24 months after the initiation of effective cART in the subgroup of patients with the worst immune status.
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Affiliation(s)
- Vincenzo Malagnino
- Clinic of Infectious Diseases, Policlinico Tor Vergata, V. Montpelier 1, 00133, Rome, Italy.,Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Carlotta Cerva
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Elisabetta Teti
- Clinic of Infectious Diseases, Policlinico Tor Vergata, V. Montpelier 1, 00133, Rome, Italy
| | - Laura Campogiani
- Clinic of Infectious Diseases, Policlinico Tor Vergata, V. Montpelier 1, 00133, Rome, Italy
| | - Mirko Compagno
- Clinic of Infectious Diseases, Policlinico Tor Vergata, V. Montpelier 1, 00133, Rome, Italy
| | - Luca Foroghi Biland
- Clinic of Infectious Diseases, Policlinico Tor Vergata, V. Montpelier 1, 00133, Rome, Italy.,Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Laura Saderi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Daniele Armenia
- Saint Camillus International, UniCamillus, University of Health Sciences, Rome, Italy
| | - Romina Salpini
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Marco Iannetta
- Clinic of Infectious Diseases, Policlinico Tor Vergata, V. Montpelier 1, 00133, Rome, Italy.,Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Massimo Andreoni
- Clinic of Infectious Diseases, Policlinico Tor Vergata, V. Montpelier 1, 00133, Rome, Italy.,Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Loredana Sarmati
- Clinic of Infectious Diseases, Policlinico Tor Vergata, V. Montpelier 1, 00133, Rome, Italy. .,Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
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6
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Liu L, Wang L, Zhang H, Ou W, Li D, Feng Y, Zhuang H, Shao Y. Changing Epidemiology of Hepatitis B Virus and Hepatitis C Virus Coinfection in a Human Immunodeficiency Virus-Positive Population in China: Results From the Third and Fourth Nationwide Molecular Epidemiologic Surveys. Clin Infect Dis 2021; 73:642-649. [PMID: 34398954 DOI: 10.1093/cid/ciab058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The transmission of human immunodeficiency virus (HIV) and hepatitis B virus (HBV)/hepatitis C virus (HCV) is similar in modes/routes and related risk factors. Understanding the long-term changing epidemiology of HIV, HBV, and HCV coinfection is important for evaluation of existing disease control policy and healthcare planning. We describe HBV and HCV coinfection based on the latest 2 nationwide molecular epidemiologic surveys of HIV infection in mainland China in 2007 and 2015. METHODS Seroprevalence of HBV and HCV infections was determined in antiretroviral treatment (ART)-naive people living with HIV-1 (PLWH) from 2 nationwide surveys conducted in 2007 and 2015 from 31 provinces, municipalities, and autonomous regions in mainland China. Demographic characteristics, route of HIV transmission, and CD4+ cell count were captured in the national database. Logistic regression was used to study the association between coinfection status and possible relevant risk factors. RESULTS A total of 6611 (n = 1571 in 2007; n = 5040 in 2015) ART-naive PLWH met the eligibility criteria. The prevalence of HBV and HCV coinfection in PLWH decreased from 61.1% in 2007 to 18.0% in 2015. Significant coinfection proportion reduction was found for HCV (from 53.7% to 4.9%), and a moderate decrease for HBV (17.8% to 13.9%). There was an increase of HBV/HIV coinfections among 12 provinces, municipalities, and autonomous regions, associated with domestic migration (adjusted odds ratio, 6.34 [95% confidence interval, 1.82-22.09]). CONCLUSIONS A significant decrease of HBV and HCV coinfection in PLWH was observed. Due to limited health resources and high transmission efficiency, concerted efforts should be made to further control viral hepatitis epidemics in HIV-positive populations.
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Affiliation(s)
- Lin Liu
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China
| | - Lin Wang
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Weidong Ou
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China
| | - Dan Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China
| | - Yi Feng
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China
| | - Hui Zhuang
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Changping District, Beijing, China.,Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
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7
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Lin L, Li TS. Multidisciplinary collaborative integrated management of increasingly prominent HIV complications in the post-cART era. HIV Med 2020; 21:683-691. [PMID: 33369030 PMCID: PMC7839721 DOI: 10.1111/hiv.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES With the prolonged survival time of AIDS patients, complications of various systems and organs of HIV infection are increasingly prominent. These diseases have become the major factors influencing the quality of life and prognosis of HIV-infected persons, and multidisciplinary cooperation treatment is urgently needed. METHODS The Chinese HIV/AIDS Clinical Trial Network has conducted a series of multicentre clinical cohort studies over the past 16 years, in which studies related to people living with HIV systemic complications. Based on the results of previous studies, this review establishes the complications of Chinese people living with HIV after long-term cART. RESULTS HIV's direct damage to human cells, chronic abnormal inflammatory activation after HIV infection, long-term drug side effects caused by cART and persistent reservoirs cause systemic complications in people living with HIV. We summarised the clinical characteristics of the complications of HIV infection in China from the aspects of the liver, cardiovascular, the nervous system, the kidney, bone metabolism, blood glucose, and lipid metabolism. CONCLUSIONS The management of the complications of HIV infection is a major link in improving the survival treatment and prognosis of patients in the future. The joint participation of doctors from different departments of general hospitals in the management of comorbidities is the main theme for future improvement of quality of life and prognosis for people living with HIV.
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Affiliation(s)
- L Lin
- Department of Infectious DiseasesPeking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - TS Li
- Department of Infectious DiseasesPeking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
- Center for AIDS ResearchChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Clinical Immunology CenterChinese Academy of Medical SciencesBeijingChina
- Tsinghua‐Peking Center for Life SciencesSchool of MedicineTsinghua UniversityBeijingChina
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8
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Salpini R, Malagnino V, Piermatteo L, Mulas T, Alkhatib M, Scutari R, Teti E, Cerva C, Yu La Rosa K, Brugneti M, Bertoli A, Rossi B, Holzmayer V, Gersch J, Kuhns M, Cloherty G, Ceccherini-Silberstein F, Perno CF, Iannetta M, Andreoni M, Sarmati L, Svicher V. Cryptic HBV Replicative Activity Is Frequently Revealed in Anti-HBc-Positive/HBsAg-Negative Patients with HIV Infection by Highly Sensitive Molecular Assays, and Can Be Predicted by Integrating Classical and Novel Serological HBV Markers. Microorganisms 2020; 8:microorganisms8111819. [PMID: 33218205 PMCID: PMC7699270 DOI: 10.3390/microorganisms8111819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
The anti-HBc-positive/HBsAg-negative status is frequent in HIV-infection and correlates with poor survival. Here, by highly-sensitive assays, we evaluate cryptic HBV replication and factors correlated with its detection in 81 anti-HBc-positive/HBsAg-negative HIV-infected patients. Patients were treated for >12 months with HBV-active modern combined antiretroviral-therapy (cART) and had serum HBV-DNA < 20 IU/mL by commercial Real-Time PCR. Serum HBV-DNA was quantified by droplet digital PCR, serum HBV-RNA by an Abbott research assay, and anti-HBc titer (proposed to infer intrahepatic cccDNA) by Lumipulse/Fujirebio. Cryptic serum HBV-DNA was detected in 29.6% of patients (median (IQR): 4(1-15) IU/mL) and serum HBV-RNA in 3.7% of patients despite HBsAg-negativity and HBV-active cART. Notably, cryptic serum HBV-DNA correlated with an advanced CDC-stage (p = 0.01) and a lower anti-HBs titer (p = 0.05), while serum HBV-RNA correlated with lower nadir CD4+ cell-count (p = 0.01). By analyzing serological HBV-markers, the combination of anti-HBs < 50 mIU/mL (indicating lower immune response) plus anti-HBc > 15COI (reflecting higher HBV replicative activity) was predictive of cryptic serum HBV-DNA (OR: 4.7(1.1-21.7), p = 0.046, PPV = 62.5%, and NPV = 72%). In conclusion, cryptic HBV-replication (not detected by classical assays) characterizes a conspicuous set of anti-HBc-positive HIV-infected patients despite HBsAg-negativity and HBV-active combined antiretroviral therapy (cART). The integration of classical and novel markers may help identify patients with cryptic HBV-replication, thus optimizing the monitoring of anti-HBc-positive/HBsAg-negative HIV-infected patients.
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Affiliation(s)
- Romina Salpini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
| | - Vincenzo Malagnino
- Clinic of Infectious Diseases, Tor Vergata University Hospital, 00133 Rome, Italy; (V.M.); (T.M.); (E.T.); (C.C.); (B.R.); (M.I.); (M.A.); (L.S.)
| | - Lorenzo Piermatteo
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
| | - Tiziana Mulas
- Clinic of Infectious Diseases, Tor Vergata University Hospital, 00133 Rome, Italy; (V.M.); (T.M.); (E.T.); (C.C.); (B.R.); (M.I.); (M.A.); (L.S.)
| | - Mohammad Alkhatib
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
| | - Rossana Scutari
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
| | - Elisabetta Teti
- Clinic of Infectious Diseases, Tor Vergata University Hospital, 00133 Rome, Italy; (V.M.); (T.M.); (E.T.); (C.C.); (B.R.); (M.I.); (M.A.); (L.S.)
| | - Carlotta Cerva
- Clinic of Infectious Diseases, Tor Vergata University Hospital, 00133 Rome, Italy; (V.M.); (T.M.); (E.T.); (C.C.); (B.R.); (M.I.); (M.A.); (L.S.)
| | - Katia Yu La Rosa
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
| | - Marta Brugneti
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
| | - Ada Bertoli
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
| | - Benedetta Rossi
- Clinic of Infectious Diseases, Tor Vergata University Hospital, 00133 Rome, Italy; (V.M.); (T.M.); (E.T.); (C.C.); (B.R.); (M.I.); (M.A.); (L.S.)
| | - Vera Holzmayer
- Abbott Molecular, Des Plaines, IL 60018-3315, USA; (V.H.); (J.G.); (M.K.); (G.C.)
| | - Jeffrey Gersch
- Abbott Molecular, Des Plaines, IL 60018-3315, USA; (V.H.); (J.G.); (M.K.); (G.C.)
| | - Mary Kuhns
- Abbott Molecular, Des Plaines, IL 60018-3315, USA; (V.H.); (J.G.); (M.K.); (G.C.)
| | - Gavin Cloherty
- Abbott Molecular, Des Plaines, IL 60018-3315, USA; (V.H.); (J.G.); (M.K.); (G.C.)
| | - Francesca Ceccherini-Silberstein
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
| | - Carlo-Federico Perno
- Microbiology and Immunology Diagnostics, Ospedale Pediatrico Bambino Gesù, 00165 Rome, Italy;
| | - Marco Iannetta
- Clinic of Infectious Diseases, Tor Vergata University Hospital, 00133 Rome, Italy; (V.M.); (T.M.); (E.T.); (C.C.); (B.R.); (M.I.); (M.A.); (L.S.)
| | - Massimo Andreoni
- Clinic of Infectious Diseases, Tor Vergata University Hospital, 00133 Rome, Italy; (V.M.); (T.M.); (E.T.); (C.C.); (B.R.); (M.I.); (M.A.); (L.S.)
| | - Loredana Sarmati
- Clinic of Infectious Diseases, Tor Vergata University Hospital, 00133 Rome, Italy; (V.M.); (T.M.); (E.T.); (C.C.); (B.R.); (M.I.); (M.A.); (L.S.)
| | - Valentina Svicher
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (R.S.); (L.P.); mohammad-- (M.A.); (R.S.); (K.Y.L.R.); (M.B.); (A.B.); (F.C.-S.)
- Correspondence:
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9
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Cao W, Hsieh E, Li T. Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges. Curr HIV/AIDS Rep 2020; 17:26-34. [PMID: 31939111 PMCID: PMC6989417 DOI: 10.1007/s11904-019-00478-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose of Review The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic increases in antiretroviral therapy (ART) coverage among HIV-infected Chinese patients. Despite limitations in the number of available free antiretroviral drugs, the overall mortality associated with HIV/AIDS has dropped from 39.3 per 100 person-years in 2002 to 3.1 in 2014. In this review, we summarize the challenges, responses, and achievements of antiretroviral therapy (ART) in China over the past 20 years. Recent Findings Continuous optimization of the Chinese National Guidelines for HIV/AIDS Diagnosis and Treatment has been guided by data from serial domestic multi-center studies aimed at evaluating efficacy and toxicity of available ART regimens among Chinese patients with HIV, with the goal of maximizing adherence, access, and efficacy. In addition, increasing attention has been focused on the importance of continuity in the HIV care cascade to promote linkage to care, and address the multidisciplinary chronic care needs HIV/AIDS patients on lifelong ART. Summary Great progress has been achieved in the past 20 years in terms of access to and optimization of antiretroviral treatment in China. As the number of patients receiving long-term ART continues to grow, the focus of HIV/AIDS treatment has gradually transitioned from urgent care to the management of non-AIDS-related chronic complications and control of chronic inflammation.
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Affiliation(s)
- Wei Cao
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Evelyn Hsieh
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Section of Rheumatology, Department of Internal Medicine, Allergy and Immunology, Yale School of Medicine, New Haven, CT, USA
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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10
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Joshi SS, Coffin CS. Hepatitis B virus lymphotropism: emerging details and challenges. Biotechnol Genet Eng Rev 2018; 34:139-151. [DOI: 10.1080/02648725.2018.1474324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shivali S. Joshi
- Calgary Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Carla S. Coffin
- Calgary Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
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11
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Toscano ALDCC, Corrêa MCM. Evolution of hepatitis B serological markers in HIV coinfected patients: a case study. Rev Saude Publica 2017; 51:24. [PMID: 28380208 PMCID: PMC5479400 DOI: 10.1590/s1518-8787.2017051006693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/17/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To describe the evolution of serological markers among HIV and hepatitis B coinfected patients, with emphasis on evaluating the reactivation or seroreversion of these markers. METHODS The study population consisted of patients met in an AIDS Outpatient Clinic in São Paulo State, Brazil. We included in the analysis all HIV-infected and who underwent at least two positive hepatitis B surface antigen serological testing during clinical follow up, with tests taken six months apart. Patients were tested with commercial kits available for hepatitis B serological markers by microparticle enzyme immunoassay. Clinical variables were collected: age, sex, CD4+ T-cell count, HIV viral load, alanine aminotransferase level, exposure to antiretroviral drugs including lamivudine and/or tenofovir. RESULTS Among 2,242 HIV positive patients, we identified 105 (4.7%) patients with chronic hepatitis B. Follow up time for these patients varied from six months to 20.5 years. All patients underwent antiretroviral therapy during follow-up. Among patients with chronic hepatitis B, 58% were hepatitis B "e" antigen positive at the first assessment. Clearance of hepatitis B surface antigen occurred in 15% (16/105) of patients with chronic hepatitis B, and 50% (8/16) of these patients presented subsequent reactivation or seroreversion of hepatitis B surface antigen. Among hepatitis B "e" antigen positive patients, 57% (35/61) presented clearance of this serologic marker. During clinical follow up, 28.5% (10/35) of those who initially cleared hepatitis B "e" antigen presented seroreversion or reactivation of this marker. CONCLUSIONS Among HIV coinfected patients under antiretroviral therapy, changes of HBV serological markers were frequently observed. These results suggest that frequent monitoring of these serum markers should be recommended.
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Affiliation(s)
- Ana Luiza de Castro Conde Toscano
- Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil.,Departamento de Doenças Infecciosas. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Maria Cássia Mendes Corrêa
- Departamento de Doenças Infecciosas. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo. Laboratório de Investigação Médica 52. São Paulo, SP, Brasil
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12
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Wu YS, Zhang WW, Ling XM, Yang L, Huang SB, Wang XC, Wu H, Cai WP, Wang M, Wang H, Liu YF, He HL, Wei FL, Wu ZY, Zhang FJ. Efficacy and Safety of Tenofovir and Lamivudine in Combination with Efavirenz in Patients Co-infected with Human Immunodeficiency Virus and Hepatitis B Virus in China. Chin Med J (Engl) 2017; 129:304-8. [PMID: 26831232 PMCID: PMC4799574 DOI: 10.4103/0366-6999.174509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: The prevalence of hepatitis B virus (HBV) infection is high among individuals infected with human immunodeficiency virus (HIV) in China. Both HIV and HBV can be treated with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC), so we evaluated the safety and efficacy of combination antiretroviral therapy (ART) that included TDF, 3TC, and efavirenz (EFV) among ART-naive individuals who were co-infected with HIV and HBV. Methods: One hundred HIV/HBV co-infected ARV-naive individuals were started on the regimen of TDF, 3TC, and EFV, and the levels of plasma HBV DNA, HIV RNA, and biochemical evaluation related to the function of liver and kidney were analyzed. Results: Concerning efficacy, this study found that by week 48, the vast majority co-infected participants receiving this ART regimen had undetectable HBV DNA levels (71%) and/or HIV RNA levels (90%). Concerning safety, this study found that the median estimated glomerular filtration rate of participants decreased from baseline (109 ml·min−1·1.73 m−2) to week 12 (104 ml·min−1·1.73 m−2) but was almost back to baseline at week 48 (111 ml·min−1·1.73 m−2). Conclusion: This combination ART regimen is safe and effective for patients with HIV/HBV co-infection. Trial Registration: ClinicalTrials.gov, NCT01751555; https://clinicaltrials.gov/ct2/show/NCT01751555.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Fu-Jie Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050; Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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13
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Floridia M, Masuelli G, Tamburrini E, Spinillo A, Simonazzi G, Guaraldi G, Degli Antoni AM, Martinelli P, Portelli V, Dalzero S, Ravizza M. HBV coinfection is associated with reduced CD4 response to antiretroviral treatment in pregnancy. HIV CLINICAL TRIALS 2017; 18:54-59. [PMID: 28067163 DOI: 10.1080/15284336.2016.1276312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the impact of Hepatitis B virus (HBV) coinfection on response to antiretroviral treatment in pregnant women with HIV. METHODS Retrospective analysis of a large case series of pregnant women with HIV in Italy; outcome measures were CD4 changes, HIV viral load, and main pregnancy outcomes (preterm delivery, low birthweight, intrauterine growth restriction, mode of delivery, and major birth defects). RESULTS Rate of HBV coinfection among 1462 pregnancies was 12.0%. Compared to the HBV-uninfected, HBV-coinfected women had a significantly lower median CD4 cell gain between first and third trimester (26.5 vs. 60 cells/mm3, p = 0.034), with similar rate of undetectable (<50 copies/ml) HIV-RNA at third trimester (70.5% vs. 65.2%, p = 0.229), and no differences in all the main maternal and infant outcomes. A multivariable linear regression analysis identified four variables significantly and independently associated with a lower CD4 response in pregnancy: HBV coinfection (-35 cells/mm3), being on antiretroviral treatment at conception (-59.7 cells/mm3), AIDS status (-59.8 cells/mm3) and higher first CD4 levels in pregnancy (-0.24 cells per unitary CD4 increase). CONCLUSIONS HBV coinfection had no adverse influence on the main pregnancy outcomes or on HIV viral load suppression in late pregnancy but was associated with a significantly reduced CD4 response in pregnancy. This effect might have clinical relevance, particularly in women with advanced immune deterioration.
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Affiliation(s)
- Marco Floridia
- a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy
| | - Giulia Masuelli
- b Department of Obstetrics and Neonatology , Città della Salute e della Scienza Hospital, and University of Turin , Turin , Italy
| | - Enrica Tamburrini
- c Department of Infectious Diseases , Catholic University , Rome , Italy
| | - Arsenio Spinillo
- d Department of Obstetrics and Gynaecology , IRCCS S. Matteo , Pavia , Italy
| | - Giuliana Simonazzi
- e Department of Medical and Surgical Sciences , Policlinico Sant'Orsola-Malpighi and University of Bologna , Bologna , Italy
| | - Giovanni Guaraldi
- f Department of Medical Specialties, Infectious Diseases Clinic , University of Modena and Reggio Emilia , Modena , Italy
| | - Anna Maria Degli Antoni
- g Department of Infectious Diseases and Hepatology , Azienda Ospedaliera di Parma , Parma , Italy
| | - Pasquale Martinelli
- h Department of Neurosciences, Reproductive and Dentistry Science , University Federico II Naples , Naples , Italy
| | - Vincenzo Portelli
- i Infectious Diseases Unit , S. Antonio Abate Hospital , Trapani , Italy
| | - Serena Dalzero
- j Department of Obstetrics and Gynaecology , DMSD San Paolo Hospital Medical School, University of Milan , Milan , Italy
| | - Marina Ravizza
- j Department of Obstetrics and Gynaecology , DMSD San Paolo Hospital Medical School, University of Milan , Milan , Italy
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Dalhatu I, Onotu D, Odafe S, Abiri O, Debem H, Agolory S, Shiraishi RW, Auld AF, Swaminathan M, Dokubo K, Ngige E, Asadu C, Abatta E, Ellerbrock TV. Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012. PLoS One 2016; 11:e0165528. [PMID: 27829033 PMCID: PMC5102414 DOI: 10.1371/journal.pone.0165528] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022] Open
Abstract
Background The Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported. Methods We evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models. Results At ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm3, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7–1.8), 12.3 (95%CI: 8.9–17.0), and 13.9 (95% CI: 10.4–18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU. Conclusion Moderate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted.
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Affiliation(s)
- Ibrahim Dalhatu
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Dennis Onotu
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Solomon Odafe
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
- * E-mail:
| | - Oseni Abiri
- School of Biomedical Informatics, University of Texas, Houston, Texas, United States of America
| | - Henry Debem
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Simon Agolory
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Ray W. Shiraishi
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Andrew F. Auld
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Mahesh Swaminathan
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Kainne Dokubo
- School of Biomedical Informatics, University of Texas, Houston, Texas, United States of America
| | - Evelyn Ngige
- National AIDS & STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Chukwuemeka Asadu
- National AIDS & STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Emmanuel Abatta
- National AIDS & STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Tedd V. Ellerbrock
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
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15
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Lamivudine Monotherapy-Based cART Is Efficacious for HBV Treatment in HIV/HBV Coinfection When Baseline HBV DNA <20,000 IU/mL. J Acquir Immune Defic Syndr 2016; 72:39-45. [PMID: 26745828 DOI: 10.1097/qai.0000000000000927] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although combination antiretroviral therapy (cART) including tenofovir (TDF)+lamivudine (3TC) or emtricitabine (FTC) is recommended for treatment of HIV/HBV coinfected patients, TDF is unavailable in some resource-limited areas. Some data suggest that 3TC monotherapy-based cART may be effective in patients with low pretreatment HBV DNA. METHODS Prospective study of 151 Chinese HIV/HBV coinfected subjects of whom 60 received 3TC-based cART and 91 received TDF+3TC-based cART. Factors associated with HBV DNA suppression at 24 and 48 weeks, including anti-HBV drugs, baseline HBV DNA, and baseline CD4 cell count, were evaluated overall and stratified by baseline HBV DNA using Poisson regression with a robust error variance. RESULTS Baseline HBV DNA ≥20,000 IU/mL was present in 48.3% and 44.0% of subjects in the 3TC and TDF groups, respectively (P = 0.60). After 48 weeks of treatment, HBV DNA suppression rates were similar between these 2 groups (96.8% vs. 98.0% for 3TC and TDF+3TC, P > 0.999) in subjects with baseline HBV DNA <20,000 IU/mL; whereas in those with baseline HBV DNA ≥20,000 IU/mL, TDF+3TC was associated with higher suppression rates (34.5% vs. 72.5% in 3TC and TDF+3TC groups, respectively, P = 0.002). In stratified multivariate regression, TDF use (RR 1.98, P = 0.010) and baseline HBV DNA (per 1 log increase in International Units Per Milliliter, RR 0.74, P < 0.001) were associated with HBV DNA suppression only when baseline HBV DNA ≥20,000 IU/mL. CONCLUSION This study suggests that 3TC monotherapy-based cART is efficacious for HBV treatment through 48 weeks in HIV/HBV coinfection when baseline HBV DNA <20,000 IU/mL. Studies with long-term follow-up are warranted to determine if this finding persists.
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16
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Remis RS, Liu J, Loutfy MR, Tharao W, Rebbapragada A, Huibner S, Kesler M, Halpenny R, Grennan T, Brunetta J, Smith G, Reko T, Kaul R. Prevalence of Sexually Transmitted Viral and Bacterial Infections in HIV-Positive and HIV-Negative Men Who Have Sex with Men in Toronto. PLoS One 2016; 11:e0158090. [PMID: 27391265 PMCID: PMC4938580 DOI: 10.1371/journal.pone.0158090] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 06/12/2016] [Indexed: 01/28/2023] Open
Abstract
Background Hepatitis B (HBV), hepatitis C (HCV) and other sexually transmitted infections (STIs) have been associated with HIV transmission risk and disease progression among gay men and other men who have sex with men (MSM), but the frequency and distribution of STIs in this community in Canada has not been extensively studied. Methods We recruited MSM living with and without HIV from a large primary care clinic in Toronto. Participants completed a detailed socio-behavioural questionnaire using ACASI and provided blood for syphilis, HIV, HBV and HCV, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), and human cytomegalovirus (CMV) serology, urine for chlamydia and gonorrhea, and a self-collected anal swab for human papillomavirus (HPV) molecular diagnostics. Prevalences were expressed as a proportion and compared using chi-square. Results 442 MSM were recruited, 294 living with HIV and 148 without. Active syphilis (11.0% vs. 3.4%), ever HBV (49.4% vs. 19.1%), HCV (10.4% vs. 3.4%), HSV-2 (55.9% vs. 38.2%), CMV (98.3% vs. 80.3%) and high-risk (HR) anal HPV (67.6% vs. 51.7%) infections were significantly more common in men living with HIV. Chlamydia and gonorrhea were infrequent in both groups. Regardless of HIV infection status, age and number of lifetime male sexual partners were associated with HBV infection and lifetime injection drug use with HCV infection. Conclusions Syphilis and viral infections, including HBV, HCV, HSV-2, CMV, and HR-HPV, were common in this clinic-based population of MSM in Toronto and more frequent among MSM living with HIV. This argues for the implementation of routine screening, vaccine-based prevention, and education programs in this high-risk population.
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Affiliation(s)
- Robert S. Remis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Juan Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mona R. Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Anuradha Rebbapragada
- Public Health Laboratory–Toronto Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sanja Huibner
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maya Kesler
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Troy Grennan
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Graham Smith
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Tatjana Reko
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Advances in the Treatment of Human Immunodeficiency Virus and Hepatitis B Virus Co-infection. INFECTION INTERNATIONAL 2016. [DOI: 10.1515/ii-2017-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractHepatitis B virus (HBV) and human immunodeficiency virus (HIV) are transmitted through the same pathways. Therefore, the incidence of HBV in the HIV-infected population is higher than that in the healthy population, and is more obvious in China given the high HBV prevalence in the country. HIV and HBV co-infection can accelerate the disease process of HBV. Moreover, the incidence of cirrhosis and end-stage liver disease is higher in patients co-infected with HIV and HBV than in patients infected HBV alone. When treating patients co-infected with HIV and HBV for HBV infection alone, care should be taken to avoid the induction of HIV resistance. HBV should be considered during drug selection for anti-retroviral treatment. Furthermore, the effective HBV treatment should be retained if anti-retroviral drugs require changing.
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Prevalence of hepatitis B and C viruses in HIV-positive patients in China: a cross-sectional study. J Int AIDS Soc 2016; 19:20659. [PMID: 26979535 PMCID: PMC4793284 DOI: 10.7448/ias.19.1.20659] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/06/2016] [Accepted: 02/16/2016] [Indexed: 12/26/2022] Open
Abstract
Introduction Liver disease related to hepatitis B (HBV) and hepatitis C (HCV) may temper the success of antiretroviral therapy (ART) in China. Limited data exist on their prevalence in HIV-positive Chinese. A multi-centre, cross-sectional study was carried out to determine the prevalence and disease characteristics of HBV and HCV co-infection in HIV-positive patients across 12 provinces. Methods HIV-positive ART-naïve patients were recruited from two parent cohorts established during November 2008–January 2010 and August 2012–September 2014. Hepatitis B surface antigen (HBsAg), hepatitis B e antigen and HCV antibody (anti-HCV) status were retrieved from parent databases at the visit prior to ART initiation. HBV DNA was then determined in HBsAg+ patients. HCV RNA was quantified in anti-HCV+ patients. Aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis-4 (FIB4) were calculated. Chi-square test, Kruskal–Wallis test and logistic regression were used for statistical analysis, as appropriate. Results Of 1944 HIV-positive patients, 186 (9.5%) were HIV–HBV co-infected and 161 (8.3%) were HIV–HCV co-infected. The highest HIV–HBV prevalence (14.5%) was in Eastern China while the highest HIV–HCV prevalence was in the Central region (28.2%). HIV–HBV patients had lower median CD4 + T cell count (205 cells/μL) than either HIV monoinfected (242 cells/μL, P=0.01) or HIV–HCV patients (274 cells/μL, P=0.001). Moderate-to-significant liver disease was present in >65% of the HIV–HCV, ~35% of the HIV–HBV and ~20% of the HIV monoinfected patients. Independent associations with moderate-to-significant liver disease based on APRI included HBV (Odds ratio, OR 2.37, P < 0.001), HCV (OR 9.64, P<0.001), CD4 count≤200 cells/μL (OR 2.55, P<0.001) and age ≥30 years (OR 1.80, P=0.001). Conclusions HBV and HCV prevalence is high in HIV-positive Chinese and differs by geographic region. HBV and HCV co-infection and HIV monoinfection are risks for moderate-to-significant liver disease. Only HIV–HBV is associated with greater HIV-related immunosuppression. Incorporating screening and management of hepatitis virus infections into Chinese HIV programmes is needed.
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Li Y, Xie J, Han Y, Wang H, Lv W, Guo F, Qiu Z, Li Y, Du S, Song X, Zhu T, Thio CL, Li T. Combination Antiretroviral Therapy Is Associated With Reduction in Liver Fibrosis Scores in HIV-1-Infected Subjects. Medicine (Baltimore) 2016; 95:e2660. [PMID: 26844493 PMCID: PMC4748910 DOI: 10.1097/md.0000000000002660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
HIV increases the risk of liver disease as do two common coinfections, hepatitis B and C viruses (HBV and HCV). However, whether combination antiretroviral therapy (cART) reverses or exacerbates hepatic fibrosis remains unclear.This was an observational retrospective study. cART-naïve HIV-infected subjects without a history of substance abuse (including alcohol) had liver disease stage determined by aspartate aminotransferase-to-platelet ratio indices (APRIs) and fibrosis-4 (FIB-4) before and 24 and 48 weeks after cART. All the data were retrieved from previously established cohorts. Values before and after cART were compared using Wilcoxon test for paired samples. Regression analyses were used to determine factors associated with moderate-to-severe liver disease.Of the 1105 HIV-infected subjects, 120 were HBV coinfected and 64 were HCV coinfected. About 20% of HIV monoinfected participants had APRI and FIB-4 scores consistent with moderate-to-significant fibrosis compared to ∼36% of HIV-HBV coinfected and 67% to 77% of HIV-HCV coinfected participants. In adjusted analyses compared with HIV monoinfection, HBV coinfection was associated with 1.18-fold higher APRI (P < 0.001) and a 1.12-fold higher FIB-4 (P = 0.007) prior to cART; while HCV coinfection was associated with 1.94-fold higher APRI (P < 0.001) and a 1.43-fold higher FIB-4 (P < 0.001). After 48 weeks of cART, both fibrosis scores decreased in all subjects; however, HCV coinfection was still associated with higher fibrosis scores at week 48 compared to HIV monoinfection.cART was associated with improvement in hepatic fibrosis scores in the majority of HIV-hepatitis coinfected and HIV-monoinfected Chinese participants.
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Affiliation(s)
- Yijia Li
- From the Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China (YL, JX, YH, HW, WL, FG, ZQ, YL, SD, XS, TZ, TL) and Division of Infectious Diseases, Department of Medicine, Johns Hopkins University (CLT), Baltimore, MD
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Fan HW, Guo FP, Li YJ, Li N, Li TS. Prevalence of thrombocytopenia among Chinese adult antiretroviral-naïve HIV-positive patients. Chin Med J (Engl) 2015; 128:459-64. [PMID: 25673446 PMCID: PMC4836247 DOI: 10.4103/0366-6999.151078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The prevalence of thrombocytopenia among Chinese antiretroviral therapy (ART)-naïve HIV-infected adults has not been well-described. The aim of this study was to investigate the prevalence and associated risk factors of thrombocytopenia among Chinese ART-naïve HIV-infected adults. METHODS We performed a cross-sectional study of Chinese adult ART-naïve HIV-infected patients from September 2005 through August 2014. Socio-demographic variables and laboratory results including platelets, CD4+ cell count, and viral load were obtained from medical records. Factors and outcomes associated with thrombocytopenia were assessed using logistic regression. RESULTS A total of 1730 adult ART-naïve HIV-infected patients was included. The mean age was 38 years. The prevalence of thrombocytopenia was 4.5%. There were significant differences in the prevalence of thrombocytopenia between patients <30 years of age (2.8%) and 30-39 years (4.0%) compared with patients greater than 50 years (7.0%) (P = 0.006 and P = 0.044, respectively). The prevalence of thrombocytopenia was also significantly different between patients with CD4+ counts of 200-349 cells/mm 3 (3.3%) and >350 cells/mm 3 (2.8%) compared with patients with CD4+ counts of 50-199 cells/mm 3 (7.1%) (P = 0.002 and P = 0.005, respectively). The prevalence of thrombocytopenia was significantly different by hepatitis C virus antibody (HCV-Ab) seropositivity (10.2% for HCV-Ab positive vs. 3.9% for HCV-Ab negative, P = 0.001). We observed differences in prevalence of thrombocytopenia by mode of transmission of HIV infection: Blood transmission (10.7%) versus men who have sex with men (3.9%) (P = 0.002) and versus heterosexual transmission (3.9%) (P = 0.001). In binary logistic regression analyses, age ≥ 50 years, HCV-Ab positivity and having a CD4+ cell count of 50-199 cells/mm 3 were significantly associated with thrombocytopenia with adjusted odds ratio of 2.482 (95% confidence interval [CI]: 1.167, 5.281, P = 0.018), 2.091 (95% CI: 1.078, 4.055, P = 0.029) and 2.259 (95% CI: 1.028, 4.962, P = 0.042), respectively. CONCLUSIONS Thrombocytopenia is not common among adult ART-naïve HIV-infected patients in China. Older age (age over 50 years), HCV-Ab positivity and lower CD4+ cell count are associated with an increased risk of thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.
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Affiliation(s)
| | | | | | | | - Tai-Sheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Huang SM, Cai WP, Hu FY, Lan Y, Liao BL, Chen YP, Tang XP. Epidemiological and clinical characteristics of hepatitis B virus in HIV-infected patients in Guangdong, China. Int J STD AIDS 2015; 27:890-7. [PMID: 26384940 DOI: 10.1177/0956462415600570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/20/2015] [Indexed: 01/04/2023]
Abstract
This study investigated the epidemiological and clinical characteristics of hepatitis B virus (HBV) in HIV-infected adults at the time of antiretroviral therapy (ART) initiation in Guangdong province, China. A total of 2793 HIV-infected adults were enrolled between January 2004 and September 2011. Demographic data and laboratory parameters were collected, HBV-DNA levels were measured, and HBV genotypes were identified before ART initiation. The prevalence of hepatitis B surface antigen (HBsAg) in HIV-infected patients was 13.2%. A total of 266 HIV/HBV co-infected patients and 1469 HIV mono-infected patients were recruited. The median alanine aminotransferase and aspartate aminotransferase levels of HIV/HBV co-infected patients were higher than HIV mono-infected patients (32 U/L vs. 22 U/L, p < 0.001 and 35 U/L vs. 24 U/L, p < 0.001, respectively), whereas the median CD4 cell count of HIV/HBV co-infected patients was lower than HIV mono-infected patients (59 cells/mm(3) vs. 141 cells/mm(3), p < 0.001). The level of CD4 cell count was lower in hepatitis B e-antigen (HBeAg)-positive co-infected patients than HBeAg-negative patients (36 cells/mm(3) vs. 69 cells/mm(3), p = 0.014). A similar result was found in high level of HBV-DNA and low level of HBV-DNA groups (33 cells/mm(3) vs. 89 cells/mm(3), p < 0.001). HBV genotypes were classified as genotypes B and C. Patients infected with genotypes B and C differed significantly in terms of proportion of those who were HBeAg-positive (40.5% vs. 62.2%, p = 0.014). This study indicates a high prevalence of HBsAg in HIV-infected adults in Guangdong. The level of CD4 cell count in HIV/HBV co-infected patients was much lower than HIV mono-infected patients, especially in patients who were HBeAg-positive and had a high level of HBV-DNA. The predominant HBV genotype in HIV/HBV co-infected patients is genotype B.
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Affiliation(s)
- S M Huang
- Department of Infectious Diseases, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - W P Cai
- Number Eight People's Hospital of Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - F Y Hu
- Number Eight People's Hospital of Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Y Lan
- Number Eight People's Hospital of Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - B L Liao
- Number Eight People's Hospital of Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Y P Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - X P Tang
- Department of Infectious Diseases, The First Affiliated Hospital of Jinan University, Guangzhou, China Number Eight People's Hospital of Guangzhou, Guangzhou Medical University, Guangzhou, China
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Gu L, Han Y, Li Y, Zhu T, Song X, Huang Y, Yang F, Guan S, Xie J, Gohda J, Hosoya N, Kawana-Tachikawa A, Liu W, Gao GF, Iwamoto A, Li T, Ishida T. Emergence of Lamivudine-Resistant HBV during Antiretroviral Therapy Including Lamivudine for Patients Coinfected with HIV and HBV in China. PLoS One 2015; 10:e0134539. [PMID: 26288093 PMCID: PMC4543549 DOI: 10.1371/journal.pone.0134539] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/11/2015] [Indexed: 02/06/2023] Open
Abstract
In China, HIV-1-infected patients typically receive antiretroviral therapy (ART) that includes lamivudine (3TC) as a reverse-transcriptase inhibitor (RTI) (ART-3TC). Previous studies from certain developed countries have shown that, in ART-3TC, 3TC-resistant HBV progressively emerges at an annual rate of 15–20% in patients coinfected with HIV-1 and HBV. This scenario in China warrants investigation because >10% of all HIV-infected patients in China are HBV carriers. We measured the occurrence of 3TC-resistant HBV during ART-3TC for HIV-HBV coinfection and also tested the effect of tenofovir disoproxil fumarate (TDF) used as an additional RTI (ART-3TC/TDF) in a cohort study in China. We obtained 200 plasma samples collected from 50 Chinese patients coinfected with HIV-1 and HBV (positive for hepatitis B surface antigen) and examined them for the prevalence of 3TC-resistant HBV by directly sequencing PCR products that covered the HBV reverse-transcriptase gene. We divided the patients into ART-3TC and ART-3TC/TDF groups and compared the efficacy of treatment and incidence of drug-resistance mutation between the groups. HIV RNA and HBV DNA loads drastically decreased in both ART-3TC and ART-3TC/TDF groups. In the ART-3TC group, HBV breakthrough or insufficient suppression of HBV DNA loads was observed in 20% (10/50) of the patients after 96-week treatment, and 8 of these patients harbored 3TC-resistant mutants. By contrast, neither HBV breakthrough nor treatment failure was recorded in the ART-3TC/TDF group. All of the 3TC-resistant HBV mutants emerged from the cases in which HBV DNA loads were high at baseline. Our results clearly demonstrated that ART-3TC is associated with the emergence of 3TC-resistant HBV in patients coinfected with HIV-1 and HBV and that ART-3TC/TDF reduces HBV DNA loads to an undetectable level. These findings support the use of TDF-based treatment regimens for patients coinfected with HIV-1 and HBV.
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Affiliation(s)
- Lijun Gu
- China-Japan Joint Laboratory of Molecular Immunology & Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
- Research Center for Asian Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yang Han
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Yijia Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Ting Zhu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Ying Huang
- China-Japan Joint Laboratory of Molecular Immunology & Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
| | - Feifei Yang
- China-Japan Joint Laboratory of Molecular Immunology & Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
| | - Shuo Guan
- China-Japan Joint Laboratory of Molecular Immunology & Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
| | - Jing Xie
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Jin Gohda
- China-Japan Joint Laboratory of Molecular Immunology & Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
- Research Center for Asian Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Noriaki Hosoya
- Research Center for Asian Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Ai Kawana-Tachikawa
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Wenjun Liu
- China-Japan Joint Laboratory of Molecular Immunology & Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
| | - George Fu Gao
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
| | - Aikichi Iwamoto
- Research Center for Asian Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Research Center for Asian Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China
- * E-mail: (TI); (TL)
| | - Takaomi Ishida
- China-Japan Joint Laboratory of Molecular Immunology & Molecular Microbiology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, P.R. China
- Research Center for Asian Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- * E-mail: (TI); (TL)
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HIV-1 subtype B/B' and baseline drug resistance mutation are associated with virologic failure: a multicenter cohort study in China. J Acquir Immune Defic Syndr 2015; 68:289-97. [PMID: 25501612 DOI: 10.1097/qai.0000000000000473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Distribution of HIV-1 subtypes, transmitted drug resistance (TDR)/drug resistance mutation (DRM), and their impact on response to combination antiretroviral therapy remain poorly understood in China. METHODS We analyzed data from our multicenter cohort study with 444 antiretroviral-naive participants recruited between 2008 and 2010. HIV-1 subtype and tropism were determined by V3 sequencing, and TDR/DRM was determined by Pol sequencing. Virologic and immunologic responses were monitored over 96 weeks of follow-up. The initial combination antiretroviral therapy regimen for all patients was nevirapine + lamivudine + zidovudine or stavudine. Analysis 1 included patients who finished 96 weeks of follow-up (n = 379), and analysis 2 included all 444 patients. RESULTS Subtype B/B' was associated with higher prevalence of TDR/DRM to nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors. Median time to HIV-1 suppression was 18 weeks in all 3 subtype groups. In Cox proportional models for viral suppression, neither viral tropism nor HIV-1 subtypes had any impact on viral suppression; however, subtypes CRF01_AE and C/CRF07_BC/CRF08_BC were associated with lower risk of virologic failure compared with subtype B/B', with adjusted hazard ratio of 0.11 (P = 0.032) and 0.06 (P = 0.036), respectively in analysis 1, 0.42 (P = 0.047) and 0.22 (P = 0.008), respectively in analysis 2. This association was attenuated by adding DRM profiles to multivariate regression models. Neither subtype nor HIV-1 tropism affected immunologic response. CONCLUSIONS HIV-1 subtype tended to be associated with virologic but not immunologic response; this effect could be ascribed to baseline DRM.
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Li T, Xie J, Li Y, Routy JP, Li Y, Han Y, Qiu Z, Lv W, Song X, Sun M, Zhang X, Wang F, Jiang H. Tripterygium wilfordii Hook F extract in cART-treated HIV patients with poor immune response: a pilot study to assess its immunomodulatory effects and safety. HIV CLINICAL TRIALS 2015; 16:49-56. [PMID: 25874991 DOI: 10.1179/1528433614z.0000000005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite combination antiretroviral therapy (cART), 20% of HIV-infected patients are unable to achieve adequate immunologic recovery, in which immune activation plays a crucial role. We hypothesize that extract of Tripterygium wilfordii Hook F (TwHF), a Chinese medication used to treat autoimmune diseases, has immunomodulatory effects that may help CD4 cell recovery. METHODS Eighteen cART-treated HIV-infected patients virally suppressed for over 12 months with suboptimal CD4 cell recovery were enrolled. TwHF extract was administered at a dosage of 10 mg three times daily for 12 months. T-cell subsets and activation markers were evaluated at baseline and during follow-up. The trial was registered at Clinicaltrials.gov (NCT02002286). RESULTS TwHF extract was associated with a mean increase in CD4 cell count of 88 cells/μl (95% confidential interval [CI], 72-105 cells/μl) after one year of treatment. A significant increase in the mean rate of CD4 cell recovery (26 before vs 75 cells/μl/year after TwHF use, P < 0.001) was observed. Analysis of 13 patients with activation profiles suggested that TwHF extract was associated with a decrease in T-cell immune activation which was temporally correlated with CD4 cell recovery. No discontinuation of TwHF extract was reported. CONCLUSION Use of TwHF extract in HIV-infected patients was associated with a reduction in T-cell activation and improved CD4 recovery with an excellent safety profile.
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Yang R, Gui X, Xiong Y, Gao SC, Yan Y. Impact of hepatitis B virus infection on HIV response to antiretroviral therapy in a Chinese antiretroviral therapy center. Int J Infect Dis 2014; 28:29-34. [PMID: 25236390 DOI: 10.1016/j.ijid.2014.07.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/17/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Co-infection with hepatitis B virus (HBV) and HIV is common in China; however, the impact of HBV on long-term antiretroviral therapy (ART) outcomes has not been fully characterized. METHODS Patients were classified as being HIV mono-infected (hepatitis B surface antigen (HBsAg)-negative) or HIV/HBV co-infected (HBsAg-positive). The effects of HBV on HIV virological response, changes in CD4 cell counts, hepatotoxicity, and mortality among Chinese patients receiving ART were evaluated. RESULTS The HIV/HBV co-infection rate in our cohort was 9.9% (354/3562). Five hundred and fifty HIV mono-infected and 78 HIV/HBV co-infected individuals fulfilled the inclusion criteria. HIV/HBV co-infected individuals were less likely to achieve HIV-RNA suppression and a CD4 increase than HIV mono-infected individuals at 48 months post-ART. Greater hepatotoxicity and a more rapid occurrence of death were observed in HIV/HBV co-infected subjects. HBV-related mortality accounted for 84.2% (16/19) of the total deaths in HIV/HBV co-infected subjects. CONCLUSIONS HBV co-infection can affect late immunological and virological responses to ART and increase the risk of hepatotoxicity. Mortality due to liver disease was high among HIV/HBV co-infected individuals in this study, despite HBV-active ART. As long as HIV/HBV co-infected persons need anti-HBV therapy, they should be recommended ART that includes agents with activity against both HIV and HBV, regardless of the CD4 cell count level.
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Affiliation(s)
- Rongrong Yang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Xien Gui
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China.
| | - Yong Xiong
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Shi-Cheng Gao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Yajun Yan
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
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Milazzo L, Antinori S. Hepatitis virus and HIV interactions. THE LANCET. INFECTIOUS DISEASES 2014; 14:1025-1027. [PMID: 25303842 DOI: 10.1016/s1473-3099(14)70853-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Milazzo
- Department of Biomedical and Clinical Sciences L Sacco, University of Milan, Via GB Grassi 74, 20157, Milan, Italy.
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences L Sacco, University of Milan, Via GB Grassi 74, 20157, Milan, Italy
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Zhang F, Zhu H, Wu Y, Dou Z, Zhang Y, Kleinman N, Bulterys M, Wu Z, Ma Y, Zhao D, Liu X, Fang H, Liu J, Cai WP, Shang H. HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010-12: a retrospective observational cohort study. THE LANCET. INFECTIOUS DISEASES 2014; 14:1065-1072. [PMID: 25303841 DOI: 10.1016/s1473-3099(14)70946-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China. METHODS We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010-11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care. FINDINGS 33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53-2·37) and HCV co-infection (1·46, 1·25-1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89-1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02-1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80-1·10) or HCV co-infection (1·10, 0·97-1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16-1·62) and HCV co-infection (1·30, 1·17-1·45), but not HBV co-infection (0·93, 0·82-1·05), than among those with HIV only. INTERPRETATION Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression. FUNDING The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.
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Affiliation(s)
- Fujie Zhang
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China; First Affiliated Hospital of China Medical University, Liaoning, China
| | - Hao Zhu
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China
| | - Yasong Wu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Zhihui Dou
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Yao Zhang
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Nora Kleinman
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China; Association of Schools and Programs of Public Health, Washington, DC, USA
| | - Marc Bulterys
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China; Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, CA, USA
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Ye Ma
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Decai Zhao
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Xia Liu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Hua Fang
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Jing Liu
- First Affiliated Hospital of China Medical University, Liaoning, China
| | - Wei-Ping Cai
- Department of Infectious Diseases, Guang Zhou Eighth People's Hospital, Guangdong, China
| | - Hong Shang
- First Affiliated Hospital of China Medical University, Liaoning, China.
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Coffin CS, Mulrooney-Cousins PM, Osiowy C, van der Meer F, Nishikawa S, Michalak TI, van Marle G, Gill MJ. Virological characteristics of occult hepatitis B virus in a North American cohort of human immunodeficiency virus type 1-positive patients on dual active anti-HBV/HIV therapy. J Clin Virol 2014; 60:347-53. [PMID: 24881491 DOI: 10.1016/j.jcv.2014.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Occult hepatitis B virus infection (OBI) is defined as low-level HBV DNA presence in serum, liver and/or peripheral blood mononuclear cells (PBMC) in individuals that lack serum hepatitis B virus surface antigen (HBsAg). HIV+ patients with OBI may be at risk for HBV reactivation, and often receive dual active anti-HBV/HIV therapy, such as lamivudine (LMV). OBJECTIVES To determine the presence of OBI in a North American cohort of HIV-1-positive patients. STUDY DESIGN/METHODS 45 HIV-1-positive, serum HBsAg-negative patients, reactive for antibodies to HBV core antigen (anti-HBc), were tested for HBV DNA in plasma and for HBV DNA and covalently closed circular DNA (cccDNA) in PBMC. Ten patients were re-tested after ∼5-10 years, including genotyping and clonal sequence analysis of the HBV polymerase (P) gene and overlapping HBV surface (S) gene from 8 PBMC samples. RESULTS Overall, 42% (19/45) tested HBV DNA positive, especially in PBMC (18/45), including 3/18 that were reactive for HBV cccDNA, compared to 17% (8/45) that were HBV DNA reactive in plasma. In 8 patients on LMV, sequence analysis in PBMC showed that all were HBV genotype C or D. Several carried HBV P region variants at residues associated with anti-HBV drug resistance and overlapping S gene region within the major HBsAg "a determinant". CONCLUSION OBI is common in HIV-positive, anti-HBc reactive patients on anti-HBV/HIV therapy, particularly in PBMC. HBV sequence analysis revealed that all had HBV genotype C or D and often had P/overlapping S gene variants possibly associated with dual-active anti-HIV/HBV therapy.
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Affiliation(s)
- Carla S Coffin
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Microbiology, Immunology and Infectious Diseases, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Patricia M Mulrooney-Cousins
- Molecular Virology and Hepatology Research Group, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Frank van der Meer
- Department of Microbiology, Immunology and Infectious Diseases, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Faculty of Veterinary Medicine, University of Calgary, AB, Canada
| | - Sandra Nishikawa
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Microbiology, Immunology and Infectious Diseases, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tomasz I Michalak
- Molecular Virology and Hepatology Research Group, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Guido van Marle
- Department of Microbiology, Immunology and Infectious Diseases, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M John Gill
- Department of Microbiology, Immunology and Infectious Diseases, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Luo L, Zeng Y, Li T, Lv W, Wang H, Guo F, Han Y, Xie J, Qiu Z, Li Y, Song X, Zhu T, Zhang X, Li L, Ye Y, He Y, Lu H, Huang A, Tang X, Wang H, Zhang T, Gao G, Lei J, Wu X, Sun Y, Bai J, Li K. Prospective echocardiographic assessment of cardiac structure and function in Chinese persons living with HIV. Clin Infect Dis 2014; 58:1459-66. [PMID: 24569532 DOI: 10.1093/cid/ciu086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Persons living with human immunodeficiency virus (HIV) are at increased risk of developing cardiovascular disease. Few studies have focused on echocardiographic abnormalities in this population. METHODS China AIDS Clinical Trial 0810 is a prospective, multicenter cohort study of persons living with HIV (PLWH). We performed an echocardiography substudy of 325 PLWH. We examined the prevalence of left ventricular systolic dysfunction (LVSD), diastolic dysfunction (DD), pulmonary arterial hypertension (PAH), and increased left ventricular mass (ILVM) in antiretroviral therapy (ART)-naive PLWH at baseline and week 48 after initiation of ART. RESULTS Compared with age- and sex-matched healthy controls, PLWH had a higher prevalence of DD (16.5% vs 7.2%, P < .027) and a marginally significant higher prevalence of LVSD (7.3% vs 2.1%, P = .056). The increase in the prevalence of DD from baseline to week 48 in PLWH was marginally significant (P = .056). No significant difference was observed in the prevalence of LVSD, PAH, or ILVM at baseline and week 48 in PLWH. In logistic regression analysis of all participants, age was significantly associated with LVSD; HIV infection, age, and hypertension were associated with DD whereas HIV infection and hypertension were associated with ILVM at baseline. Logistic regression analysis of PLWH showed that only age was significantly associated with LVSD and DD. CONCLUSIONS The prevalence of echocardiographic abnormalities was significantly higher in ART-naive PLWH than in controls. HIV infection was significantly associated with cardiac abnormalities. No significant change in echocardiographic abnormalities was observed after 48 weeks of ART. Longer-term prospective studies are warranted.
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Affiliation(s)
- Ling Luo
- Department of Infectious Disease
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CRF01_AE subtype is associated with X4 tropism and fast HIV progression in Chinese patients infected through sexual transmission. AIDS 2014; 28:521-30. [PMID: 24472744 DOI: 10.1097/qad.0000000000000125] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The molecular epidemiology of the HIV-1 CRF01_AE subtype as a risk factor for fast HIV-1 progression remains poorly understood. METHODS We analyzed HIV-1 tropism by utilizing samples from 201 treatment-naive patients in our multicenter cohort (12 research centers in different provinces of China). Tropism was determined by V3 loop sequencing. Data from 235 treatment-naive patients infected sexually (including aforementioned 201 patients) in this cohort with date of estimated seroconversion (EDS) were retrospectively evaluated. Median time from EDS to AIDS was analyzed by Kaplan-Meier curves. Hazard ratios were determined by Cox proportional model. RESULTS CRF01_AE subtype was predominant (46.0%), especially in the MSM group. Further analysis revealed that the proportion of X4 tropism was higher in the CRF01_AE subtype (45.5%) than in others (C/CRF07_BC/CRF08_BC, 4.3%; B, 6.1%; P <0.001). CRF01_AE subtype was associated with faster progression from EDS to AIDS (4.8 vs. 6.4 years, P = 0.018) compared with non-CRF01_AE subtypes. In a multivariate model, the adjusted hazard ratio (aHR) of CRF01_AE was 1.42 (95% confidence interval, CI 0.99-2.03, P = 0.057), independent of HIV-1 viral load; it was also associated with fast progression to advanced immunodeficiency (aHR, 1.81, 95% CI 1.03-3.18, P = 0.038). CONCLUSION CRF01_AE, a predominant HIV-1 subtype in Chinese HIV-1 sexually infected patients, tends to be associated with fast progression to AIDS and advanced immunodeficiency, which might be ascribed to high proportion of X4 tropism. Further investigation of these risk factors may have significant implications to clinical practice and policy-making.
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Hepatitis B virus prevalence, risk factors and genotype distribution in HIV infected patients from West Java, Indonesia. J Clin Virol 2014; 59:235-41. [PMID: 24529845 DOI: 10.1016/j.jcv.2014.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/19/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Indonesia currently faces both an increasing HIV incidence and a high hepatitis B virus (HBV) burden. OBJECTIVE The objective of our study is to examine the prevalence, risk factors, and genotypic distribution of HBV infection among HIV infected patients in West Java, Indonesia. STUDY DESIGN A cross sectional study was conducted among a cohort of HIV infected patients in 2008. Demographic and disease related variables were compared between HBV negative and positive patients. Logistic regression was applied to determine risk factors for HBV co-infection. HBV and HIV genotyping was performed in co-infected patients. RESULTS Of 636 HIV-infected patients, the rate of HBV co-infection was 7%. The proportion of males was higher in HBV/HIV co-infected patients than in HIV mono-infected patients (93% vs. 72%, P=0.001). A history of injecting drug use (IDU), but not tattooing, was associated with HBV co-infection [P=0.035 OR 2.41 (95% CI 1.06-5.47)]. In the HIV and HBV treatment naive patients, CD4 cells counts <50cells/mm(3), HIV-RNA plasma ≥10,000copies/ml and AST level above normal were more often found in patients with high HBV-DNA levels (≥20,000IU/ml) as compared to those with low HBV DNA (<20.000IU/ml) (P<0.05). As in the general population, B3 was the dominant subtype in HBV co-infected patients. CONCLUSION The prevalence of active HBV infection and the genotype distribution among HIV infected individuals is similar to the overall population in Java. However, an increased prevalence was observed in men with a history of IDU, underlining the need for routine HBV screening and monitoring.
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The interaction of CD4 T-cell count and nevirapine hepatotoxicity in China: a change in national treatment guidelines may be warranted. J Acquir Immune Defic Syndr 2013; 62:540-5. [PMID: 23288032 DOI: 10.1097/qai.0b013e3182845cc7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Nevirapine (NVP), a still widely used nonnucleoside reverse transcriptase inhibitor, can cause severe hepatotoxicity. Previous studies suggest that CD4 cell counts more than 250 cells per microliter in women and more than 400 cells per microliter in men are risk factors for NVP-related hepatotoxicity. These studies have informed Chinese national treatment guidelines. We evaluate whether current Chinese guidelines for NVP use are appropriate. METHODS Longitudinal data were pooled from 2 clinical trials between 2005 and 2009 across mainland China. Five hundred sixty-six antiretroviral therapy-naive Chinese patients were given NVP-containing antiretroviral therapy for 24 weeks. Hepatotoxicity was defined as alanine aminotransferase, aspartate transaminase, or total bilirubin level greater than 1.25 times the upper limit of normal range. Severe hepatotoxicity was defined as greater than 5 times the upper limit of normal range. RESULTS One hundred ninety-seven (36.1%) patients developed hepatotoxicity during treatment, including 42 (7.7%) patients with severe hepatotoxicity. CD4 cell count more than 250 cells per microliter was an independent predictor for hepatotoxicity both in men [relative risk = 1.22 (95% confidence interval: 1.04 to 1.44)] and in women [relative risk = 1.72 (95% confidence interval: 1.20 to 2.46)]. Severe hepatotoxicity was also more common among all persons with CD4 >250 cells per microliter. CONCLUSIONS Hepatotoxicity was a common adverse effect of NVP among men and women with CD4 >250 cells per microliter. Chinese treatment guidelines should be considered to reflect this risk.
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Ruiz-Artacho P, Téllez-Molina M, Vergas-García J, Altali-Alhames K, Estrada-Pérez V, Fernández-Cruz-Pérez A. HIV/HBV coinfection: Serological control and therapeutic strategies. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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The Role of Sexually Transmitted Infections in HIV-1 Progression: A Comprehensive Review of the Literature. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:176459. [PMID: 26316953 PMCID: PMC4437436 DOI: 10.1155/2013/176459] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 05/28/2013] [Indexed: 01/01/2023]
Abstract
Due to shared routes of infection, HIV-infected persons are frequently coinfected with other sexually transmitted infections (STIs). Studies have demonstrated the bidirectional relationships between HIV and several STIs, including herpes simplex virus-2 (HSV-2), hepatitis B and C viruses, human papilloma virus, syphilis, gonorrhea, chlamydia, and trichomonas. HIV-1 may affect the clinical presentation, treatment outcome, and progression of STIs, such as syphilis, HSV-2, and hepatitis B and C viruses. Likewise, the presence of an STI may increase both genital and plasma HIV-1 RNA levels, enhancing the transmissibility of HIV-1, with important public health implications. Regarding the effect of STIs on HIV-1 progression, the most studied interrelationship has been with HIV-1/HSV-2 coinfection, with recent studies showing that antiherpetic medications slow the time to CD4 <200 cells/µL and antiretroviral therapy among coinfected patients. The impact of other chronic STIs (hepatitis B and C) on HIV-1 progression requires further study, but some studies have shown increased mortality rates. Treatable, nonchronic STIs (i.e., syphilis, gonorrhea, chlamydia, and trichomonas) typically have no or transient impacts on plasma HIV RNA levels that resolve with antimicrobial therapy; no long-term effects on outcomes have been shown. Future studies are advocated to continue investigating the complex interplay between HIV-1 and other STIs.
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Ruiz-Artacho P, Téllez-Molina MJ, Vergas-García J, Altali-Alhames K, Estrada-Pérez V, Fernández-Cruz-Pérez A. HIV/HBV coinfection: serological control and therapeutic strategies. Rev Clin Esp 2013; 213:285-90. [PMID: 23541287 DOI: 10.1016/j.rce.2013.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/10/2012] [Accepted: 01/23/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The evolution and prognosis of patients co-infected by human immunodeficiency virus (HIV) and hepatitis B (HBV) is not well know. This study describes the treatment and serological, virological and biochemical and elastographic responses of HIV and HBV-coinfected patients. PATIENTS AND METHODS A descriptive, retrospective study of all the HIV/HBV-coinfected patients seen in a specialized HIV department between 1 January 2007 and 30 November 2008 was performed. Virological and serological determinations of HIV and HBV infections as well as CD4 lymphocytes and transaminases prior to antiretroviral treatment and at the time of analysis were obtained. RESULTS A total of 54 (5.4%) cases of HIV/HBV coinfection were identified. The median nadir and current CD4 were 179 and 437 cells/L, respectively. There was undetectable RNA-HIV in 70%. There were 52 patients (96.3%) who followed active drugs treatment against HBV. After treatment, 68.8% had HBeAg negative result, with 81.6% virologic response. The HBsAg became negative in 10.4%. ALT was normal in 75.5%. FibroScan(®) was performed in 30 (55.6%) patients, yielding a median of 7.0kPa. CONCLUSIONS The results obtained suggest a good serological, virological and biochemical control of HIV/HBV-coinfected patients with treatments recommended by clinical guidelines.
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Affiliation(s)
- P Ruiz-Artacho
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
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