The outcome of chronic hepatitis B and the efficacy of interferon alpha (IFN-alpha) remain controversial in HIV-positive patients.
In this study, a team from France analyzed the influence of HIV coinfection on patients' response to IFN-alpha therapy.
They assessed long-term virologic status, progression to cirrhosis, and patient mortality.
The research team retrospectively followed-up 141 consecutive hepatitis B e antigen-positive patients, of which 69 were HIV positive. Follow-up was for 45 months.
|Short-term response to interferon alpha therapy was not significantly different in HIV-positive patients, but was poorer in cases of low CD4 cell count.|
The team found that the short-term response to IFN-alpha therapy was not significantly different in HIV-positive and HIV-negative patients (28% versus 51%), but it was found to be poorer in cases of low CD4 cell count.
However, the hepatitis B virus (HBV) reactivation rate was higher in HIV-positive patients, again associated with low CD4 cell count.
The researchers determined that the risk of cirrhosis was higher in HIV-positive patients with a CD4 cell count less that 200/mm3 (relative risk, 4.57). This was also the case in IFN-alpha-untreated patients (RR, 2.63), in patients over 33 years old (RR, 4.59), and in cases of high necroinflammatory score at baseline (RR, 1.27).
Furthermore, cirrhosis-related death was more frequent in HIV-positive patients with low CD4 cell count at baseline, in alcohol consumers, in IFN-alpha-untreated patients, and in patients with high histology activity index at baseline.
Dr Vincent di Martino's team concluded, "HIV coinfection was associated with poorer response to IFN-alpha therapy, more frequent HBV reactivations, and increased incidence of cirrhosis and cirrhosis-related death in cases of low CD4 count".
However, "IFN-alpha therapy decreased the incidence of HBV cirrhosis regardless of HIV status or serologic response".