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|Title: ||Outcomes of starting first-line antiretroviral therapy in hepatitis B virus/HIV-coinfected patients in Ghana|
|Authors: ||Chadwick, D.|
Phillips, Richard O.
|Issue Date: ||23-Jul-2012|
|Publisher: ||Oxford University Press|
|Citation: ||Oxford University Press 67: 2939–2942|
|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 ARTamong 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
Conclusions: HIV/HBV-coinfected Ghanaians tolerated first-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
|Description: ||An article published by Oxford University Press and available at oi:10.1093/jac/dks333|
|Appears in Collections:||College of Health Sciences|
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