Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-infected patients in Tanzania

OBJECTIVES: To evaluate the prevalence of HIV/hepatitis B virus (HBV) co-infection and relationship between HIV/HBV and health outcomes in a cohort of HIV-infected adults receiving antiretroviral treatment (ART) in urban Tanzania. DESIGN/METHODS: Clinical and immunologic responses to ART were compared longitudinally between HIV mono (HIV) and HIV/HBV co-infected (HIV/HBV) adults enrolled between November 2004 and September 2011 at the Management and Development for Health (MDH) -PEPFAR HIV Care and Treatment program in Dar es Salaam, Tanzania. RESULTS: The prevalence of HIV/HBV co-infection was 6. 2% (1079/17, 539). Compared to HIV patients, HIV/HBV patients were more likely to be male, younger, and more immunosuppressed at ART initiation. Median ART duration was 18. 6 interquartile range (IQR) 4. 9-29. 5 and 18. 2 (IQR 4. 2-27. 2) months in HIV and HIV/HBV patients, respectively. In multivariate analyses, a trend towards a higher risk of mortality was observed in HIV/HBV patients hazard ratio 1. 18 95% confidence interval (CI) 0. 98-1. 42, P = 0. 07 as well as lower CD4 (+) cell counts throughout recovery (P 120 and >200 IU/l). There was a higher risk of mortality in HIV/HBV patients vs. HIV patients on non-tenofovir (TDF) -containing ART hazard ratio 1. 28 (95% CI 1. 02-1. 61), P < 0. 03, whereas there was no difference in the risk of mortality observed in HIV/HBV patients vs. HIV patients on TDF-containing ART hazard ratio 0. 70 (95% CI 0. 34-1. 44), P < 0. 33; interaction P = 0. 30. CONCLUSIONS: HBV co-infection significantly impacted ART outcomes in this Tanzanian HIV-infected population. Further research is needed to confirm the potential beneficial effects of TDF on mortality in HIV/HBV co-infected individuals in these settings.