Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort
Maponga TG., McNaughton AL., Van Schalkwyk M., Hugo S., Nwankwo C., Taljaard J., Mokaya J., Smith DA., van Vuuren C., Goedhals D., Gabriel S., Andersson MI., Preiser W., van Rensburg C., Matthews PC.
<jats:p>Objective: Prompted by international targets for elimination of hepatitis B virus (HBV) infection, we set out to study adults with chronic HBV (CHB) infection in South Africa. We sought 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 as guidelines for antiviral therapy change over time. Design: We prospectively recruited 112 adults with CHB, of whom 38 (34%) had HIV coinfection, over one year in a university hospital in Cape Town, South Africa. We recorded cross-sectional demographic, clinical and laboratory data. Results: Adults with HBV monoinfection were comparable to those with HBV/HIV coinfection in terms of age, sex and body mass. HBeAg-positive status was more common among those with coinfection (p=0.01). Compared to HBV/HIV coinfection, HBV monoinfected patients were less likely to be on antiviral treatment and less likely to have been assessed by fibroscan (p<0.0001 in each case); they were also more likely to have detectable HBV viraemia (p=0.01), moderate/severe thrombocytopaenia (p=0.007), elevated bilirubin (p=0.002), and APRI score >2 (p=0.02), suggesting underlying liver disease. Three cases of hepatocellular carcinoma were reported, all in patients with HBV monoinfection. Conclusion: Individuals with HBV monoinfection are disadvantaged in terms of clinical assessment and appropriate antiviral therapy compared to those with HIV coinfection, associated with relatively worse liver health. Enhanced advocacy, education, resources and infrastructure are required to optimise interventions for CHB.</jats:p>