Genotype G Linked With Liver Fibrosis in Hepatitis B-HIV Coinfection
The progression of fibrosis correlated with the presence of genotype G infection, CD4+ cell count below 350/mm3 at baseline, older age, and greater length of antiretroviral therapy.
Hepatitis B virus (HBV) genotype G is associated with an increased progression of liver fibrosis in patients with comorbid HIV and HBV, according to study results recently published in the Journal of Medical Virology.
Investigators conducted a prospective cohort study to seek the association between HBV genotype G and role it plays in liver fibrosis. A commercial assay was used to measure plasma DNA viral load of HBV every 6 months after a baseline measurement. The FibroTest was used to quantify liver fibrosis 1 to 2 times per year, and both regression and progression of fibrosis were assessed for the duration of the follow-up period. Statistical comparisons with categorical variables were performed using Fisher's exact test or Pearson's χ2 test, and the Kruskal-Wallis test was used for continuous variables.
This study included 158 participants with HIV and HBV coinfection, of whom 88.6% were men and whose median age was 39 years. HBV genotype A was most common (62.7%), followed by G (15.8%), D (10.8%), and E (10.8%). At baseline, F3 to F4 liver fibrosis was observed in 43 participants, 7 of whom had demonstrated regression to F0, F1, or F2 within the follow-up period (median 83 months). Conversely, 19 out of 115 participants with F0, F1, or F2 fibrosis at the start of the study progressed to F3 or F4 fibrosis by the end of the study period. The progression of fibrosis correlated with the presence of genotype G infection (P <.01), CD4+ cell count below 350/mm3 at baseline (P <.01), older age (P <.005), and greater length of antiretroviral therapy (P <.03). Those with genotype G infection and F0, F1, or F2 fibrosis at baseline exhibited a higher rate of FibroTest increase than those without genotype G infection (P =.002). Participants with F3 or F4 fibrosis at baseline showed lower HBV genotype E (P =.04) and higher hepatitis C virus and hepatitis D virus (P =.04 for both).
The study researchers concluded that "the majority of HIV/HBV co-infected patients in our cohort had stable levels of liver fibrosis, despite increasing treatment with the more potent [nucleoside/nucleotide analogue] tenofovir. HBV genotype G was significantly associated with fibrosis progression, along with increasing age, baseline immunosuppression and transaminases. HBV genotyping is perhaps of some use in clinical settings for HIV-HBV co-infected patients; however, further research is required to determine if this genotype is linked to more severe liver-related morbidity and mortality."
This study received funding from Gilead Sciences, Inc.
Malagnino V, Bottero J, Miailhes P, et al. Hepatitis B virus genotype G and liver fibrosis progression in chronic hepatitis B and human immunodeficiency virus coinfection [published online November 15, 2018]. _J Med Virol._doi: 10.1002/jmv.25360