Vincenzo Malagnino, Alessandro Cozzi-Lepri, Valentina Svicher, Enrico Girardi, Carlo Federico Perno, Annalisa Saracino, Gianluca Cuomo, Stefano Rusconi, Massimo Puoti, Antonella D'Arminio Monforte, Massimo Andreoni, Loredana Sarmati, ICONA Foundation Study Group
{"title":"接受抗逆转录病毒疗法的艾滋病病毒感染者的乙型肝炎病毒感染标志物与病毒学反弹风险之间的关系。","authors":"Vincenzo Malagnino, Alessandro Cozzi-Lepri, Valentina Svicher, Enrico Girardi, Carlo Federico Perno, Annalisa Saracino, Gianluca Cuomo, Stefano Rusconi, Massimo Puoti, Antonella D'Arminio Monforte, Massimo Andreoni, Loredana Sarmati, ICONA Foundation Study Group","doi":"10.1111/hiv.13680","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>The aim of this analysis was to investigate the impact of hepatitis B virus (HBV) coinfection on the risk of HIV viral rebound (VR) after achieving suppression for the first time following initiation of antiretroviral therapy (ART) in the real-world setting.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Patients living with HIV (PLWH) who were enrolled in the ICONA Foundation Study cohort and achieved viral suppression ≤50 copies/mL for the first time after starting ART were prospectively evaluated and divided in three exposure groups according to serology test results: (a) HIV-monoinfected; (b) HIV-positive/HBcAb-positive/HBsAg-negative; (c) HIV-positive/HBsAg-positive. The occurrence of VR, defined as two consecutive HIV-RNA values >50 copies/mL after achieving viral suppression for the first time (baseline), was investigated.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Standard survival analysis by means of Kaplan–Meier curves and Cox regression analysis with the serology exposure fitted as a time-fixed covariate measured at baseline was employed after controlling for key confounding factors.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of a total of 5657 patients included, 4090 (72%) were HIV-monoinfected, 1342 (23.7%)were HBcAb-positive, and 225 (3.9%) were HbsAg-positive coinfected. Overall, 654 (11.5%) PLWH experienced VR > 50 copies/mL during follow-up. After controlling for all sources of measured confounding, coinfected PLWH showed an increased risk of experiencing VR compared with those who were HIV-monoinfected. In particular, the strongest associations were seen for the HIV/HBsAg-positive participants [adjusted hazard ratio (aHR) = 1.56, 95% confidence interval (CI): 1.03–2.38, <i>p</i> = 0.037] but an excess of risk was also seen in those who were HIV-positive/HBcAb-positive/HBsAg-negative (aHR = 1.25, 95% CI: 1.00–1.55, <i>p</i> = 0.047).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Coinfection with HBV seems to have an impact on the probability of maintaining HIV viral suppression achieved for the first time after ART initiation. Of note, even PLWH positive for HBcAb, a marker of inactive HBV infection, appeared to be at higher risk of VR compared with those who were HIV-monoinfected and their HIV-RNA should be carefully monitored.</p>\n </section>\n </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"25 10","pages":"1101-1111"},"PeriodicalIF":2.8000,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between markers of hepatitis B virus infection and risk of virological rebound in people with HIV receiving antiretroviral therapy\",\"authors\":\"Vincenzo Malagnino, Alessandro Cozzi-Lepri, Valentina Svicher, Enrico Girardi, Carlo Federico Perno, Annalisa Saracino, Gianluca Cuomo, Stefano Rusconi, Massimo Puoti, Antonella D'Arminio Monforte, Massimo Andreoni, Loredana Sarmati, ICONA Foundation Study Group\",\"doi\":\"10.1111/hiv.13680\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>The aim of this analysis was to investigate the impact of hepatitis B virus (HBV) coinfection on the risk of HIV viral rebound (VR) after achieving suppression for the first time following initiation of antiretroviral therapy (ART) in the real-world setting.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design</h3>\\n \\n <p>Patients living with HIV (PLWH) who were enrolled in the ICONA Foundation Study cohort and achieved viral suppression ≤50 copies/mL for the first time after starting ART were prospectively evaluated and divided in three exposure groups according to serology test results: (a) HIV-monoinfected; (b) HIV-positive/HBcAb-positive/HBsAg-negative; (c) HIV-positive/HBsAg-positive. The occurrence of VR, defined as two consecutive HIV-RNA values >50 copies/mL after achieving viral suppression for the first time (baseline), was investigated.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Standard survival analysis by means of Kaplan–Meier curves and Cox regression analysis with the serology exposure fitted as a time-fixed covariate measured at baseline was employed after controlling for key confounding factors.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Of a total of 5657 patients included, 4090 (72%) were HIV-monoinfected, 1342 (23.7%)were HBcAb-positive, and 225 (3.9%) were HbsAg-positive coinfected. Overall, 654 (11.5%) PLWH experienced VR > 50 copies/mL during follow-up. After controlling for all sources of measured confounding, coinfected PLWH showed an increased risk of experiencing VR compared with those who were HIV-monoinfected. In particular, the strongest associations were seen for the HIV/HBsAg-positive participants [adjusted hazard ratio (aHR) = 1.56, 95% confidence interval (CI): 1.03–2.38, <i>p</i> = 0.037] but an excess of risk was also seen in those who were HIV-positive/HBcAb-positive/HBsAg-negative (aHR = 1.25, 95% CI: 1.00–1.55, <i>p</i> = 0.047).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Coinfection with HBV seems to have an impact on the probability of maintaining HIV viral suppression achieved for the first time after ART initiation. Of note, even PLWH positive for HBcAb, a marker of inactive HBV infection, appeared to be at higher risk of VR compared with those who were HIV-monoinfected and their HIV-RNA should be carefully monitored.</p>\\n </section>\\n </div>\",\"PeriodicalId\":13176,\"journal\":{\"name\":\"HIV Medicine\",\"volume\":\"25 10\",\"pages\":\"1101-1111\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-06-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"HIV Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/hiv.13680\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"HIV Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hiv.13680","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
研究目的本分析旨在研究在真实世界环境中，乙型肝炎病毒（HBV）合并感染对开始抗逆转录病毒疗法（ART）后首次实现病毒抑制后的 HIV 病毒反弹（VR）风险的影响：设计：对加入 ICONA 基金会研究队列并在开始抗逆转录病毒疗法后首次实现病毒抑制≤50 拷贝/毫升的 HIV 感染者（PLWH）进行前瞻性评估，并根据血清学检测结果将其分为三个暴露组：（a）HIV 单感染组；（b）HIV 阳性/HBcAb 阳性/HBsAg 阴性组；（c）HIV 阳性/HBsAg 阳性组。VR 是指首次（基线）实现病毒抑制后连续两次 HIV-RNA 值>50 拷贝/毫升：方法：在控制了主要混杂因素后，采用卡普兰-梅耶曲线和考克斯回归分析法进行标准生存分析，将血清学暴露作为基线测量的时间固定协变量：在纳入的 5657 名患者中，4090 人（72%）为 HIV 单感染者，1342 人（23.7%）为 HBcAb 阳性，225 人（3.9%）为 HbsAg 阳性的合并感染者。总体而言，654 名（11.5%）PLWH 在随访期间的 VR > 50 copies/mL。在控制了所有测量混杂因素后，与艾滋病病毒感染者相比，合并感染的艾滋病病毒感染者发生 VR 的风险更高。其中，HIV/HBsAg 阳性参与者的相关性最强[调整后危险比 (aHR) = 1.56，95% 置信区间 (CI)：1.03-2.38，p = 0.037]，但 HIV 阳性/HBcAb 阳性/HBsAg 阴性参与者的风险也有所增加（aHR = 1.25，95% CI：1.00-1.55，p = 0.047）：结论：HBV 合并感染似乎会影响开始接受抗逆转录病毒疗法后首次实现的 HIV 病毒抑制的维持概率。值得注意的是，即使是 HBcAb 阳性的 PLWH（一种非活动性 HBV 感染的标志物），与 HIV 单感染者相比，VR 的风险似乎也更高，因此应仔细监测他们的 HIV RNA。
Association between markers of hepatitis B virus infection and risk of virological rebound in people with HIV receiving antiretroviral therapy
Objectives
The aim of this analysis was to investigate the impact of hepatitis B virus (HBV) coinfection on the risk of HIV viral rebound (VR) after achieving suppression for the first time following initiation of antiretroviral therapy (ART) in the real-world setting.
Design
Patients living with HIV (PLWH) who were enrolled in the ICONA Foundation Study cohort and achieved viral suppression ≤50 copies/mL for the first time after starting ART were prospectively evaluated and divided in three exposure groups according to serology test results: (a) HIV-monoinfected; (b) HIV-positive/HBcAb-positive/HBsAg-negative; (c) HIV-positive/HBsAg-positive. The occurrence of VR, defined as two consecutive HIV-RNA values >50 copies/mL after achieving viral suppression for the first time (baseline), was investigated.
Methods
Standard survival analysis by means of Kaplan–Meier curves and Cox regression analysis with the serology exposure fitted as a time-fixed covariate measured at baseline was employed after controlling for key confounding factors.
Results
Of a total of 5657 patients included, 4090 (72%) were HIV-monoinfected, 1342 (23.7%)were HBcAb-positive, and 225 (3.9%) were HbsAg-positive coinfected. Overall, 654 (11.5%) PLWH experienced VR > 50 copies/mL during follow-up. After controlling for all sources of measured confounding, coinfected PLWH showed an increased risk of experiencing VR compared with those who were HIV-monoinfected. In particular, the strongest associations were seen for the HIV/HBsAg-positive participants [adjusted hazard ratio (aHR) = 1.56, 95% confidence interval (CI): 1.03–2.38, p = 0.037] but an excess of risk was also seen in those who were HIV-positive/HBcAb-positive/HBsAg-negative (aHR = 1.25, 95% CI: 1.00–1.55, p = 0.047).
Conclusions
Coinfection with HBV seems to have an impact on the probability of maintaining HIV viral suppression achieved for the first time after ART initiation. Of note, even PLWH positive for HBcAb, a marker of inactive HBV infection, appeared to be at higher risk of VR compared with those who were HIV-monoinfected and their HIV-RNA should be carefully monitored.
期刊介绍：
HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.
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