A Prospective Cohort Study of Immunologic and Virologic Outcomes in Patients with HIV/AIDS and Hepatitis Virus Co-Infection in Jos, Nigeria

Abstract

In this era of highly active antiretroviral therapy (HAART), hepatitis B and C virus (HBV and HCV) co-infection have emerged as significant co-morbid conditions. Local reports indicate that co-infection is not uncommon in Nigeria as in other sub-Saharan African countries.Whether treatment outcomes of HIV monoinfected patients differ from those with co-infection remains largely unknown. We hypothesised that coinfected patients will have lower CD4+ count recovery and viral load reduction followingHAART. A cohort study in antiretroviral therapy-naïve HIV-infected adults involving 150 cases (HIV and coinfection) and 150 controls (HIV infection only). Patients' care was according to the National guidelines and patients received first line therapy mostly comprising Lamivudine, Stavudine and Nevirapine. Medication adherence was monitored using pharmacy computerised system, and CD4+ cell counts and HIV viral load (VL) were compared at baseline, 3 and 6 months of therapy. There were 98(65.3%) and 96(64%) female cases and controls (p=0.79) respectively.The mean ages of cases and controls were 38±8.4 and 37±8.9 years (p=0.20) respectively.Cases comprised 73(48%) HBV, 70(47%) HCV and 7(5%) with both HBV and HCV infection.Medication adherence was >95% in both arms. Attrition rate was 2.7%(8); seven of them were coinfected. Five cases (3.3%) compared to zero controls developed clinical hepatitis. The proportions of patients with CD4+ count <200 cells/μl among cases and controls were 111(74%) and 109(72%), p=0.36 at baseline; 66(45.5%) and 64(42.7%), p=0.21 at 3 months; 60(42%) and 56(37.6%), p=0.40 at 6 months respectively. Significantly, more controls (60.7%) had CD4+ increases 50cells/μl at 3 months compared to 37(54.5%) HCV+ cases (p=0.03). No significant difference in CD4+ counts between controls and cases at 6 months. The baseline median VL for cases and controls were log  4.95 and log  4.83 (p=0.17) respectively. The proportions of cases
and controls with undetectable VLat 3 and 6 months were 96(66.2%) and 97(65.5%); p=0.74, and 116(81.1%) and 97(79.3%); p=0.10 respectively. Co-infection has limited impact on immunologic and virologic outcomes, but may be an important cause of hepatotoxicity.

KeyWords: HIV/AIDS, Hepatitis virus Co-Infection,HAART Accepted as poster at 14th International Congress on Infectious Diseases, Miami Florida USA