Influence of HIV infection on the response to interferon therapy and the long-term outcome of chronic hepatitis B

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GASTROENTEROLOGY

December 2002 . Volume 123 . Number 6

Clinical-Liver, Pancreas, and Biliary Tract

Influence of HIV infection on the response to interferon therapy and the

long-term outcome of chronic hepatitis B

di o* Thierry Thevenot* Jean-François Colin* Nathalie Boyer*

Michèle ot* Françoise Degos* Jean-Pierre Coulaud? Jean-Louis Vilde?

François Vachon? Claude Degott§ Dominique Valla* Marcellin*

Abstract

Background & Aims: The outcome of chronic hepatitis B and the efficacy of

interferon alfa (IFN-) remain controversial in human immunodeficiency virus

(HIV)-positive patients. We analyzed the influence of HIV coinfection on the

response to IFN- therapy, long-term virologic status, progression to

cirrhosis, and mortality.

Methods: This was a retrospective follow-up cohort study of 141 consecutive

hepatitis B e antigen-positive patients (69 HIV positive) followed up for 45

months.

Results: The short-term response to IFN- therapy was not significantly

different in HIV-positive and HIV-negative patients (28% vs. 51%; P = 0.06)

but was poorer in cases of low CD4 cell count (P = 0.038). The hepatitis B

virus (HBV) reactivation rate was higher in HIV-positive patients (P =

0.033) and was associated with low CD4 cell count. The risk of cirrhosis was

higher in HIV-positive patients with a CD4 cell count <200/mm3 (relative

risk [RR], 4.57; P = 0.007), in IFN--untreated patients (RR, 2.63; P =

0.041), in patients older than 33 years (RR, 4.59; P = 0.008), and in cases

of high necroinflammatory score at baseline (RR, 1.27; P = 0.010).

Cirrhosis-related death was more frequent in HIV-positive patients with low

CD4 cell count at baseline (P = 0.041), in alcohol consumers (P = 0.001), in

IFN--untreated patients (P = 0.052), and in patients with high histology

activity index at baseline (P = 0.005).

Conclusions: HIV coinfection was associated with poorer response to IFN-

therapy, more frequent HBV reactivations, and increased incidence of

cirrhosis and cirrhosis-related death in cases of low CD4 count. IFN-

therapy decreased the incidence of HBV cirrhosis regardless of HIV status or

serologic response.

Publishing and Reprint Information

*Service d'Hépatologie, INSERM U481 et Centre de Recherche Claude Bernard

sur les hépatites virales, and §Service d'Anatomie Pathologique, Hôpital

Beaujon AP-HP, Clichy; and ?Services des Maladies Infectieuses et CISIH,

Hôpital Bichat-Claude Bernard, Paris, France

Received August 13, 2001.

Accepted August 15, 2002.

GASTROENTEROLOGY 2002;123:1812-1822

Address requests for reprints to: Marcellin, M.D., Service

d'Hépatologie, Hôpital Beaujon, 100 Bd du Général Leclerc, 92110 Clichy,

France. e-mail: marcellin@... ; fax: (33) 1 47 30 94 40.

Dr. Di o's present address is: Service d'Hépato-Gastroentérologie, GH

Pitié-Salpétrière, 75013 Paris, France.

Dr. Thevenot's present address is: Service d'Hépato-Gastroentérologie, CH de

Cambrai 516 avenue de Paris, 59407 Cambrai Cedex, France.

© 2002 by the American Gastroenterological Association

0016-5085/02/$35.00 doi:10.1053/gast.2002.37061