Outcomes of starting first-line antiretroviral therapy in hepatitis B virus/HIV-coinfected patients in Ghana
Identifieur interne : 000791 ( Main/Exploration ); précédent : 000790; suivant : 000792Outcomes of starting first-line antiretroviral therapy in hepatitis B virus/HIV-coinfected patients in Ghana
Auteurs : D. Chadwick [Royaume-Uni] ; M. Ankcorn [Royaume-Uni] ; F. Sarfo [Ghana] ; R. Phillips [Ghana] ; Z. Fox [Royaume-Uni] ; A. Garcia [Royaume-Uni] ; L. Appiah [Ghana] ; G. Bedu-Addo [Ghana] ; A. M. Geretti [Royaume-Uni]Source :
- Journal of antimicrobial chemotherapy : (Print) [ 0305-7453 ] ; 2012.
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Abstract
Objectives: HIV/hepatitis B virus (HBV) coinfection is common in Ghana, where first-line antiretroviral therapy (ART) comprises lamivudine with zidovudine or stavudine and nevirapine or efavirenz. Little is known about ART outcomes in the context of coinfection. This study evaluated outcomes of ART among HIV/HBV-coinfected Ghanaians, focusing on locally available parameters. Patients and methods: An observational study comparing clinical and virological outcomes in HIV-infected individuals who were either hepatitis B surface antigen (HBsAg) positive or HBsAg negative was conducted over 36 months. Clinical events, hepatic transaminases, CD4 count and body mass index (BMI) were evaluated among 143 HBsAg-positive and 228 HBsAg-negative patients. In a random subset of HBsAg-positive patients, HBV-DNA levels and polymerase sequences were analysed. Results: Comparing HBsAg-positive and HBsAg-negative patients, 44/143 (30.8%) and 83/228 (36.4%) defaulted follow-up, 15/143 (10.5%) and 30/228 (13.2%) experienced a new clinical event, and 8/143 (5.6%) and 11/228 (4.8%) discontinued their initial regimen, respectively. Transaminase levels were higher in HBsAg-positive patients, although elevations were low grade. HBV coinfection was associated with an adjusted 2.04 (95% CI 0.59-3.49) cells/mm3/month smaller CD4 cell increase; there was no significant effect on BMI changes. After a median of 9 months of ART, 64/66 (97.0%) patients showed detectable HBV-DNA (median 3.3 log10 IU/mL; IQR 2.6-6.2); 12/53 (22.6%) of these showed lamivudine-associated resistance mutations. Conclusions: HIV/HBV-coinfected Ghanaians tolerated frst-line ART well, but experienced blunted CD4 cell responses. There was evidence of ongoing HBV replication, mild but persistent transaminase elevations and emerging lamivudine resistance in a proportion of treated patients, indicating the potential for progressive liver damage.
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Fox</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>University College London Medical School, Gower Street</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Garcia, A" sort="Garcia, A" uniqKey="Garcia A" first="A." last="Garcia">A. Garcia</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>University College London Medical School, Gower Street</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Royal Free Hampstead NHS Trust, Pond Street</s1><s2>London</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Appiah, L" sort="Appiah, L" uniqKey="Appiah L" first="L." last="Appiah">L. Appiah</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Komfo Anokye Teaching Hospital, PO Box 1934</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Bedu Addo, G" sort="Bedu Addo, G" uniqKey="Bedu Addo G" first="G." last="Bedu-Addo">G. Bedu-Addo</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Komfo Anokye Teaching Hospital, PO Box 1934</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Kwame Nkrumah University of Science and Technology, Private Bag</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Geretti, A M" sort="Geretti, A M" uniqKey="Geretti A" first="A. M." last="Geretti">A. M. Geretti</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>University College London Medical School, Gower Street</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Royal Free Hampstead NHS Trust, Pond Street</s1><s2>London</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0012007</idno><date when="2012">2012</date><idno type="stanalyst">PASCAL 13-0012007 INIST</idno><idno type="RBID">Pascal:13-0012007</idno><idno type="wicri:Area/PascalFrancis/Corpus">000011</idno><idno type="wicri:Area/PascalFrancis/Curation">000118</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000017</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000017</idno><idno type="wicri:doubleKey">0305-7453:2012:Chadwick D:outcomes:of:starting</idno><idno type="wicri:Area/Main/Merge">000792</idno><idno type="wicri:Area/Main/Curation">000791</idno><idno type="wicri:Area/Main/Exploration">000791</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Outcomes of starting first-line antiretroviral therapy in hepatitis B virus/HIV-coinfected patients in Ghana</title><author><name sortKey="Chadwick, D" sort="Chadwick, D" uniqKey="Chadwick D" first="D." last="Chadwick">D. Chadwick</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Clinical Infection, The James Cook University Hospital, Marton Road</s1><s2>Middlesbrough</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Middlesbrough</wicri:noRegion></affiliation></author><author><name sortKey="Ankcorn, M" sort="Ankcorn, M" uniqKey="Ankcorn M" first="M." last="Ankcorn">M. Ankcorn</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Clinical Infection, The James Cook University Hospital, Marton Road</s1><s2>Middlesbrough</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Middlesbrough</wicri:noRegion></affiliation></author><author><name sortKey="Sarfo, F" sort="Sarfo, F" uniqKey="Sarfo F" first="F." last="Sarfo">F. Sarfo</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Komfo Anokye Teaching Hospital, PO Box 1934</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Phillips, R" sort="Phillips, R" uniqKey="Phillips R" first="R." last="Phillips">R. Phillips</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Komfo Anokye Teaching Hospital, PO Box 1934</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Kwame Nkrumah University of Science and Technology, Private Bag</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Fox, Z" sort="Fox, Z" uniqKey="Fox Z" first="Z." last="Fox">Z. Fox</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>University College London Medical School, Gower Street</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Garcia, A" sort="Garcia, A" uniqKey="Garcia A" first="A." last="Garcia">A. Garcia</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>University College London Medical School, Gower Street</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Royal Free Hampstead NHS Trust, Pond Street</s1><s2>London</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Appiah, L" sort="Appiah, L" uniqKey="Appiah L" first="L." last="Appiah">L. Appiah</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Komfo Anokye Teaching Hospital, PO Box 1934</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Bedu Addo, G" sort="Bedu Addo, G" uniqKey="Bedu Addo G" first="G." last="Bedu-Addo">G. Bedu-Addo</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Komfo Anokye Teaching Hospital, PO Box 1934</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Kwame Nkrumah University of Science and Technology, Private Bag</s1><s2>Kumasi</s2><s3>GHA</s3><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Geretti, A M" sort="Geretti, A M" uniqKey="Geretti A" first="A. M." last="Geretti">A. M. Geretti</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>University College London Medical School, Gower Street</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Royal Free Hampstead NHS Trust, Pond Street</s1><s2>London</s2><s3>GBR</s3><sZ>6 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of antimicrobial chemotherapy : (Print)</title><title level="j" type="abbreviated">J. antimicrob. chemother. : (Print)</title><idno type="ISSN">0305-7453</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of antimicrobial chemotherapy : (Print)</title><title level="j" type="abbreviated">J. antimicrob. chemother. : (Print)</title><idno type="ISSN">0305-7453</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Antiretroviral agent</term><term>Antiviral</term><term>First line treatment</term><term>Ghana</term><term>Hepatitis B virus</term><term>Human</term><term>Mixed infection</term><term>Prognosis</term><term>Viral hepatitis B</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Pronostic</term><term>Traitement de première intention</term><term>Antirétroviral</term><term>Antiviral</term><term>SIDA</term><term>Virus hépatite B</term><term>Hépatite virale B</term><term>Homme</term><term>Infection mixte</term><term>Ghana</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives: HIV/hepatitis B virus (HBV) coinfection is common in Ghana, where first-line antiretroviral therapy (ART) comprises lamivudine with zidovudine or stavudine and nevirapine or efavirenz. Little is known about ART outcomes in the context of coinfection. This study evaluated outcomes of ART among HIV/HBV-coinfected Ghanaians, focusing on locally available parameters. Patients and methods: An observational study comparing clinical and virological outcomes in HIV-infected individuals who were either hepatitis B surface antigen (HBsAg) positive or HBsAg negative was conducted over 36 months. Clinical events, hepatic transaminases, CD4 count and body mass index (BMI) were evaluated among 143 HBsAg-positive and 228 HBsAg-negative patients. In a random subset of HBsAg-positive patients, HBV-DNA levels and polymerase sequences were analysed. Results: Comparing HBsAg-positive and HBsAg-negative patients, 44/143 (30.8%) and 83/228 (36.4%) defaulted follow-up, 15/143 (10.5%) and 30/228 (13.2%) experienced a new clinical event, and 8/143 (5.6%) and 11/228 (4.8%) discontinued their initial regimen, respectively. Transaminase levels were higher in HBsAg-positive patients, although elevations were low grade. HBV coinfection was associated with an adjusted 2.04 (95% CI 0.59-3.49) cells/mm<sup>3</sup>/month smaller CD4 cell increase; there was no significant effect on BMI changes. After a median of 9 months of ART, 64/66 (97.0%) patients showed detectable HBV-DNA (median 3.3 log<sub>10 </sub>IU/mL; IQR 2.6-6.2); 12/53 (22.6%) of these showed lamivudine-associated resistance mutations. Conclusions: HIV/HBV-coinfected Ghanaians tolerated frst-line ART well, but experienced blunted CD4 cell responses. There was evidence of ongoing HBV replication, mild but persistent transaminase elevations and emerging lamivudine resistance in a proportion of treated patients, indicating the potential for progressive liver damage.</div></front></TEI><affiliations><list><country><li>Ghana</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Chadwick, D" sort="Chadwick, D" uniqKey="Chadwick D" first="D." last="Chadwick">D. Chadwick</name></noRegion><name sortKey="Ankcorn, M" sort="Ankcorn, M" uniqKey="Ankcorn M" first="M." last="Ankcorn">M. Ankcorn</name><name sortKey="Fox, Z" sort="Fox, Z" uniqKey="Fox Z" first="Z." last="Fox">Z. Fox</name><name sortKey="Garcia, A" sort="Garcia, A" uniqKey="Garcia A" first="A." last="Garcia">A. Garcia</name><name sortKey="Garcia, A" sort="Garcia, A" uniqKey="Garcia A" first="A." last="Garcia">A. Garcia</name><name sortKey="Geretti, A M" sort="Geretti, A M" uniqKey="Geretti A" first="A. M." last="Geretti">A. M. Geretti</name><name sortKey="Geretti, A M" sort="Geretti, A M" uniqKey="Geretti A" first="A. M." last="Geretti">A. M. Geretti</name></country><country name="Ghana"><noRegion><name sortKey="Sarfo, F" sort="Sarfo, F" uniqKey="Sarfo F" first="F." last="Sarfo">F. Sarfo</name></noRegion><name sortKey="Appiah, L" sort="Appiah, L" uniqKey="Appiah L" first="L." last="Appiah">L. Appiah</name><name sortKey="Bedu Addo, G" sort="Bedu Addo, G" uniqKey="Bedu Addo G" first="G." last="Bedu-Addo">G. Bedu-Addo</name><name sortKey="Bedu Addo, G" sort="Bedu Addo, G" uniqKey="Bedu Addo G" first="G." last="Bedu-Addo">G. Bedu-Addo</name><name sortKey="Phillips, R" sort="Phillips, R" uniqKey="Phillips R" first="R." last="Phillips">R. Phillips</name><name sortKey="Phillips, R" sort="Phillips, R" uniqKey="Phillips R" first="R." last="Phillips">R. 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