Description of liver disease in a cohort of HIV/HBV coinfected patients

Sellier, P.; Schnepf, N.; Jarrin, I.; Mazeron, M.-C.; Simoneau, G.; Parrinello, M.; Evans, J.; Lafuente-Lafuente, C.

doi:10.1016/j.jcv.2009.10.010

« Previous Next »Journal of Clinical Virology
Volume 47, Issue 1 , Pages 13-17, January 2010

Description of liver disease in a cohort of HIV/HBV coinfected patients

P. Sellier
- Service de Médecine Interne A, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
- Corresponding author. Tel.: +33 1 49 95 63 39; fax: +33 1 49 95 63 40.
N. Schnepf
- Service de Bactériologie – Virologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France
I. Jarrin
- Service de Médecine Interne A, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
M.-C. Mazeron
- Service de Bactériologie – Virologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France
G. Simoneau
- Service de Médecine Interne A, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
M. Parrinello
- Centre d’Informations et de Soins de l’Immunodéficience Humaine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France
J. Evans
- Immeuble SCOR, 1, avenue du General de Gaulle, Paris la Défense Cedex, France
C. Lafuente-Lafuente
- Service de Médecine Interne A, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France

Received 16 June 2009; received in revised form 5 October 2009; accepted 7 October 2009. published online 09 November 2009.

Abstract

Background

Factors associated with advanced liver disease have been incompletely explored in HIV/HBV coinfected patients.

Objectives

To describe liver-related morbidity, mortality, and related risk factors, in HIV/HBV coinfected patients.

Study design

We followed-up 107 consecutive HIV/HBV coinfected patients. Clinical, biological and virological data were collected every 3 months. Liver-related mortality and a composite score were used to define advanced liver disease.

Results

The patients were mainly sub-Saharan Africans (61%) or Europeans (33%). Forty-four percent of patients had liver biopsy, 78% of patients received lamivudine. Advanced liver disease (ALD) was diagnosed in 19/107 patients during follow-up (mean 4.8 years): 10 extensive fibrosis, 5 cirrhosis, 3 hepatocellular carcinoma resulting from cirrhosis, and 1 fulminant hepatitis following lamivudine withdrawal. Eleven patients died, 4 from HBV-related liver disease. In univariate analysis, male gender, mean HIV and HBV viral loads, and raised AST/ALT transaminases were associated with increased risk of ALD. The strongest associations, in a multivariate model, were mean AST transaminase and cumulated time receiving lamivudine, with a favourable effect. 39% of patients with increased mean AST presented with ALD, versus 7% when normal mean AST (Relative Risk 5.5).

Conclusions

During HIV/HBV coinfection, transaminase levels are strongly associated with ALD. Normal mean AST has a high negative predictive value, contrary to previously reported data in HIV/HCV patients.

Keywords: HIV/HBV coinfection, Cohort, Liver disease