Favourable one-year ART outcomes in adult Malawians with hepatitis B and C co-infection

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http://www.journalofinfection.com/article/PIIS0163445310001295/abstract?rss=yes

JOURNAL OF INFECTION

Favourable one-year ART outcomes in adult Malawians with hepatitis B and C

co-infection

E. a, M.B.J. Beadsworthab, M. Chapondabc, B. Mhangoa, B. Faragherb, J.

Njalaa, H.W.C. Hoflanda, J. Daviesb, I.J. Hartd, N.J. Beechingb, E.E. Zijlstraa,

J.J. van Oosterhoutac

Accepted 22 April 2010. published online 31 May 2010.

Corrected Proof

Summary

Background

Few studies have investigated the impact of chronic hepatitis B and C infection

on antiretroviral therapy (ART) outcomes in sub-Saharan Africa. Hepatotoxicity

may be a particular concern in co-infected patients taking

nevirapine-stavudine-lamivudine.

Methods

We conducted a prospective cohort study of 300 Malawian adults starting ART and

describe one-year ART outcomes according to viral hepatitis status.

Results

At baseline, patients had advanced HIV disease (29.3% were in WHO stage 4; mean

CD4 = 157 cells/ìL; mean log10HIV-1 RNA = 5.24 copies/ml). Co-infection with

hepatitis B, C and B + C were present in 6.7%, 5.7% and 1.7% respectively. At 50

weeks, all-cause mortality was 43 (14.3%). Sixteen (5.3%) had transferred to

another unit. Eight (2.7%) were lost to follow up. Sixteen (5.3%) had stopped

ART. 217 (72.3%) were alive on ART, of whom 82.5% had an HIV-1 RNA <400

copies/ml at week 50. During the first 50 weeks of ART, severe hepatotoxicity

(liver enzyme values>5 times upper level of normal) occurred in 9%, but did not

result in any ART discontinuations. Clinical hepatitis or jaundice was not

observed. There were no significant differences in occurrence of hepatotoxicity,

other side effects, mortality, severe morbidity, immune reconstitution or

virological failure between hepatitis B and/or C co-infected patients and those

who were not. Viral hepatitis co-infection was not associated with severe

hepatotoxicity, mortality, severe morbidity or virological failure in

multivariate analyses.

Conclusion

Our data suggest that screening for viral hepatitis B and C and liver enzyme

monitoring may not require high priority in ART programmes in sub-Saharan

Africa.

a Department of Medicine, College of Medicine, University of Malawi, Blantyre,

Malawi

b Tropical and Infectious Disease Unit, Royal Liverpool University Hospital and

Liverpool School of Tropical Medicine, Liverpool, UK

c Malawi-Liverpool Wellcome Trust, College of Medicine, University of Malawi,

Blantyre, Malawi

d Liverpool Specialist Virology Centre, Royal Liverpool University Hospital,

Liverpool, UK

Corresponding author. Department of Medicine, College of Medicine, University of

Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi. Tel.: +265 99 99 22 682.

PII: S0163-4453(10)00129-5

doi:10.1016/j.jinf.2010.04.009

© 2010 The British Infection Society. Published by Elsevier Inc. All rights

reserved

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