COINFECTION AND SUPERINFECTION OF HEPATITIS-B VIRUS IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - NO EVIDENCE OF FASTER PROGRESSION TO AIDS

The influence of hepatitis B virus (HBV) on the natural history of hum an immunodeficiency virus (HIV) infection was evaluated in a prospecti ve study of 347 HIV-positive, AIDS-free individuals infected through i njecting drug use and sex and with known seroconversion dates. End poi nts were CD4(+) cell count <200 x 10(6) cells/L and AIDS diagnosis. At entry, 229 had seromarkers to HBV; during the study, 107 had a CD4(+) cell. count <200 x 10(6) cells/L and 66 developed AIDS. HBsAg chronic carriers, HBV infection-free subjects and those with baseline evidenc e of prior HBV infection did not differ in rates of progression to end points. Sexual transmission of HIV was significant predictor of CD4() cell decline to <200 x 10(6) cells/l [Hazard ratio (HZ): 1.56, 95% c onfidence interval (CI): 1.06-2.29, p=0.0232] and progression to AIDS (HZ:1.91, CI: 1.17-3.11, p=0.0091). 15 HIV-positive and HBV infection- free patients had HBV seroconversion. They did not differ from those w ho remained HBV infection-free in rates of progression to end points, but 40% of them became HBsAg chronic carriers. These results suggest t hat HBV has no influence on progression of HIV disease, but that patie nts who have HIV before their HBV infection are more likely to become HBsAg chronic carriers than those who are infected with HBV before HIV .