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Epidemiological, virological and clinical characteristics of HBV infection in 223 HIV co-infected patients: a French multi-centre collaborative study

Vincent Thibault1*, Catherine Gaudy-Graffin2, Philippe Colson3, Joël Gozlan4, Nathalie Schnepf5, Pascale Trimoulet6, Coralie Pallier7, Karine Saune8, Michel Branger9, Marianne Coste10, Francoise Roudot Thoraval11 and On behalf of the ANRS Multivir-HBV group

Author Affiliations

1 Pitie-Salpetriere, Paris, France

2 Université François Rabelais and CHRU de Tours, Tours, France

3 Timone University, Marseille-Timone CHU, Marseille, France

4 Saint Antoine Hospital, Paris, France

5 Lariboisiere Hospital, Paris, France

6 CHU Pellegrin, Bordeaux, France

7 Kremlin Bicetre CHU, Paris, France

8 Toulouse University Hospital, Toulouse, France

9 Bichat Hospital, Paris, France

10 Department of Pharmacy, Nantes CHU, University Hospital of Nantes, Nantes, France

11 Public Health, H Mondor Hospital, Creteil, France

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Virology Journal 2013, 10:87  doi:10.1186/1743-422X-10-87

Published: 15 March 2013

Abstract

Background

Chronic hepatitis B (CHB) is a clinical concern in human immunodeficiency virus (HIV)-infected individuals due to substantial prevalence, difficulties to treat, and severe liver disease outcome. A large nationwide cross-sectional multicentre analysis of HIV-HBV co-infected patients was designed to describe and identify parameters associated with virological and clinical outcome of CHB in HIV-infected individuals with detectable HBV viremia.

Methods

A multicenter collaborative cross-sectional study was launched in 19 French University hospitals distributed through the country. From January to December 2007, HBV load, genotype, clinical and epidemiological characteristics of 223 HBV-HIV co-infected patients with an HBV replication over 1000 IU/mL were investigated.

Results

Patients were mostly male (82%, mean age 42 years). Genotype distribution (A 52%; E 23.3%; D 16.1%) was linked to risk factors, geographic origin, and co-infection with other hepatitis viruses. This genotypic pattern highlights divergent contamination event timelines by HIV and HBV viruses. Most patients (74.7%) under antiretroviral treatment were receiving a drug with anti-HBV activity, including 47% receiving TDF. Genotypic lamivudine-resistance detected in 26% of the patients was linked to duration of lamivudine exposure, age, CD4 count and HIV load. Resistance to adefovir (rtA181T/V) was detected in 2.7% of patients. Advanced liver lesions were observed in 54% of cases and were associated with an older age and lower CD4 counts but not with viral load or genotype. Immune escape HBsAg variants were seldom detected.

Conclusions

Despite the detection of advanced liver lesions in most patients, few were not receiving anti-HBV drugs and for those treated with the most potent anti-HBV drugs, persistent replication suggested non-optimal adherence. Heterogeneity in HBV strains reflects epidemiological differences that may impact liver disease progression. These findings are strong arguments to further optimize clinical management and to promote vaccination in HIV-infected patients.

Keywords:
Genotype; HBsAg variants; HBV-HIV co-infection; Resistance mutations; Liver lesions