Editor’s Note: The 25th International AIDS Conference (AIDS 2024) was held in Munich, Germany, from July 22 to 26, 2024. This highly anticipated academic event showcased some of the most cutting-edge research in the field. Currently, clinical cures for people co-infected with HIV and HBV are still in the exploratory stage. At the conference, a research study conducted by Dr. Jie Peng’s team from the Nanfang Hospital was selected for poster presentation. The study revealed that after receiving antiretroviral therapy, HIV/HBV co-infected patients had a higher rate of HBsAg clearance. Baseline HBsAg levels and CD4 cell counts were identified as predictive factors for HBsAg clearance in these patients. We have invited Dr. Jie Peng to provide an insightful interpretation of these research findings for our readers.Abstract
This comprehensive study examined the crucial goal of achieving hepatitis B surface antigen (HBsAg) clearance in patients with chronic hepatitis B, focusing specifically on HIV/HBV co-infected individuals. The research enrolled 138 co-infected patients prospectively and 480 mono-infected patients retrospectively, utilizing propensity score matching and Kaplan-Meier analysis to compare clearance rates. Over three years, the co-infected cohort achieved a clearance rate of 11.5%, significantly surpassing the 1.0% rate observed in mono-infected patients (P<0.001). Intriguingly, ROC curve analysis revealed baseline HBsAg levels and CD4 cell counts as predictive factors, with CD4 <180 cells/uL indicating a higher clearance likelihood in the first year of treatment (78% sensitivity, 72% specificity). This finding underscores the importance of CD4 count in predicting HBsAg clearance, offering clinicians valuable insights for tailoring antiviral therapy and improving treatment outcomes in HIV/HBV co-infected patients.
Researcher Commentary
In HBV mono-infected patients, the disappearance of HBsAg after treatment is closely linked to a reduced risk of hepatocellular carcinoma. Therefore, the prognosis of HIV/HBV co-infected patients is also likely to improve with HBsAg clearance. However, in HBV mono-infected patients, HBsAg clearance rarely occurs with oral antiviral therapy. In our study, compared to HBV mono-infected patients, HIV/HBV co-infected patients showed a significantly higher HBsAg clearance rate. This may be due to the fact that HIV/HBV co-infected patients receive combination antiretroviral therapy (cART), which also includes anti-HBV treatment, potentially enhancing the immune response against HBV and leading to more favorable outcomes.
Moreover, multivariate analysis showed that a CD4 cell count of <180 cells/uL was associated with increased HBsAg clearance. Research suggests that HIV infection leads to the depletion of CD4+ T cells in the host immune system, and in the case of HIV/HBV co-infection, it impairs HBV-specific T cell responses. Our study found that CD4 counts significantly increased from baseline to the first year of treatment, and most cases of HBsAg clearance occurred within the first year of cART initiation. This suggests that HBsAg clearance may be associated with immune reconstitution, which could be an underlying mechanism for improved HBsAg clearance. Following the initiation of antiretroviral therapy, a significant decline in quantitative HBsAg and its clearance were related to an increase in CD4 counts, and a recovery of HBV-specific T cell responses in peripheral blood was observed. The reason for the higher HBsAg clearance rate in HIV/HBV co-infected patients remains unclear, but it may be related to immune reconstitution after starting cART. Further immunological studies are needed to clarify the specific mechanisms involved.
