Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort

Tongai G Maponga; Anna L McNaughton; Marije van Schalkwyk; Susan Hugo; Chikezie Nwankwo; Jantjie Taljaard; Jolynne Mokaya; David A Smith; Cloete van Vuuren; Dominique Goedhals; Shiraaz Gabriel; Monique I Andersson; Wolfgang Preiser; Christo van Rensburg; Philippa C Matthews

doi:10.1016/j.jinf.2020.04.037

Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort

J Infect. 2020 Jul;81(1):121-130. doi: 10.1016/j.jinf.2020.04.037. Epub 2020 May 1.

Authors

Affiliations

¹ Division of Medical Virology, Stellenbosch University / National Health Laboratory Service Tygerberg, Cape Town, South Africa.
² Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, UK.
³ Division of Infectious Diseases, Department of Medicine, Stellenbosch University / Tygerberg Academic Hospital, Cape Town, South Africa.
⁴ Division of Gastroenterology, Department of Medicine, Stellenbosch University / Tygerberg Academic Hospital, Cape Town, South Africa.
⁵ Division of Infectious Diseases, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
⁶ Division of Virology, Universitas Academic Laboratories, National Health Laboratory Service/University of the Free State, Bloemfontein, South Africa.
⁷ Division of Medical Virology, Stellenbosch University / National Health Laboratory Service Tygerberg, Cape Town, South Africa; Department of Microbiology and Infectious Diseases, Oxford University Hospitals, John Radcliffe Hospital, Headington, Oxford, UK.
⁸ Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, UK; Department of Microbiology and Infectious Diseases, Oxford University Hospitals, John Radcliffe Hospital, Headington, Oxford, UK; NIHR British Research Council, John Radcliffe Hospital, Headington, Oxford, UK. Electronic address: [email protected].

Abstract

Objectives: Prompted by international targets for elimination of hepatitis B virus (HBV), we set out to characterise individuals with HBV monoinfection vs. those coinfected with HBV/HIV, to evaluate the impact of therapy and to guide improvements in clinical care.

Methods: We report observational data from a real world cross-sectional cohort of 115 adults with chronic hepatitis B infection (CHB), at a university hospital in Cape Town, South Africa. HIV coinfection was present in 39 (34%) subjects. We recorded cross-sectional demographic, clinical and laboratory data.

Results: Compared to those with HIV coinfection, HBV monoinfected adults were less likely to be HBeAg-positive (p=0.01), less likely to have had assessment with elastography (p<0.0001), and less likely to be on antiviral treatment (p<0.0001); they were more likely to have detectable HBV viraemia (p=0.04), and more likely to have features of liver disease including moderate/severe thrombocytopaenia (p=0.007), elevated bilirubin (p=0.004), and elevated APRI score (p=0.02). Three cases of hepatocellular carcinoma all arose in HBV monoinfection.

Conclusions: Our data demonstrate that individuals with HBV monoinfection may be disadvantaged compared to those with HIV coinfection, highlighting potential systematic inequities in referral, monitoring and treatment.

Keywords: Coinfection; Dolutegravir; Elimination; HBV; HIV; Hepatitis B virus; Hepatocellular carcinoma; South Africa; Sustainable development goals; Tenofovir; Treatment; Viral load.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Coinfection* / drug therapy
Coinfection* / epidemiology
Cross-Sectional Studies
HIV Infections* / complications
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Hepatitis B virus
Hepatitis B*
Humans
South Africa / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding