AEGiS-15IAC: Impact of chronic viral hepatitis coinfection on response to antiretroviral therapy and HIV disease progression in the HIV-NAT cohort, Thailand, 1996-2001.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Impact of chronic viral hepatitis coinfection on response to antiretroviral therapy and HIV disease progression in the HIV-NAT cohort, Thailand, 1996-2001.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1327)

Duncombe CJ, Law WP, Mahanontharit A, Boyd MA, Ruxrungtham K, Lange JM, Phanuphak P, Cooper DA, Dore GJ
HIV-NAT, The Netherlands, Australia, Thailand Research Collaboration, Bangkok, Thailand

BACKGROUND: Chronic viral hepatitis may impact on the efficacy of antiretroviral therapy

METHODS: HIV RNA suppression, CD4 cell count recovery, and HIV disease progression were examined in a cohort of Thai HIV-infected patients enrolled in eight HIV-NAT randomized controlled trials of antiretroviral therapy. All patients (n=692) received at least two nucleoside reverse transcriptase inhibitors (NRTI), while 215 received a non-nucleoside reverse transcriptase (NNRTI)-containing regimen and 135 received a protease inhibitor (PI)-containing regimen. HIV-1 viral load and CD4 cell counts were available at baseline, and weeks 4, 8, 12, 24, 36, and 48. Hepatitis B virus (HBV) and hepatitis C virus (HCV) testing was performed on stored serum.

RESULTS: Mean age was 32.3 years, 52% were male, 11% had CDC category C HIV disease at baseline, and 22% had received prior antiretroviral therapy. Prevalence of HBV, HCV and HBV/HCV coinfection was 8.7%, 7.2%, and 0.4%, respectively. Median HIV RNA reductions (log10 copies/mL) were approximately 1.5 for HIV, HIV-HBV, HIV-HCV subgroups from week 4 through to week 48. Mean increases in CD4 cell count were significantly lower among HIV-HBV and HIV-HCV subgroups at week 4 (HIV, 62/mm³; HIV-HBV, 29/mm³; HIV-HCV, 33/mm³), however, by week 48 CD4 cell increases were similar (HIV, 115/mm³; HIV-HBV, 113/mm³; HIV-HCV, 97/mm³). Cox regression analyses showed that being HIV-HBV or HIV-HCV coinfected did not significantly decrease the likelihood of increasing CD4 cell count by 100/mm³ over 48 weeks of antiretroviral therapy. Estimated progression to new AIDS-defining event or death at week 48 was 3.3% (95% CI, 2.0-5.1%) for HIV, 6.7% (95% CI, 2.5-14.6%) for HIV-HBV, and 8.0% (95% CI, 2.2-20.5%) for HIV-HCV subgroups (log rank P >0.05).

CONCLUSIONS: An early delayed CD4 count recovery among HIV/viral hepatitis coinfected patients was not sustained, and was not associated with increased HIV disease progression compared to HIV mono-infected patients.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Thailand, CD4 Lymphocyte Count, HIV Infections, Hepatitis, Viral, Human, Antiretroviral Therapy, Highly Active, Hepatitis, Chronic, Prevalence, Hepacivirus, Male, Humans, therapy, drug therapy

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WeOrB1327