TY - JOUR
T1 - Do HIV care providers appropriately manage hepatitis B in coinfected patients treated with antiretroviral therapy?
AU - Jain, Mamta K.
AU - Opio, Christopher K.
AU - Osuagwu, Chukwuma C.
AU - Pillai, Rathi
AU - Keiser, Philip
AU - Lee, William M.
N1 - Funding Information:
We thank April Gorman for her assistance in the statistical analysis. Financial support. The Jeanne Roberts and Rollin and Mary Ella King Funds of the Southwestern Medical Foundation and K23 Career Development Award AI065630 (to M.K.J.). Potential conflicts of interest. M.K.J. is on the Speaker’s Bureau for Gilead Sciences. All other authors: no conflicts.
PY - 2007/4/1
Y1 - 2007/4/1
N2 - Background. The common occurrence of hepatitis B virus (HBV) infection in patients who carry the human immunodeficiency virus (HIV) demands that both viruses be recognized, evaluated, and treated when appropriate. Methods. We identified 357 HIV- and hepatitis B surface antigen-positive patients who underwent testing from 1999 to 2003; 155 patients who were new to our clinic and who initiated therapy for HIV and HBV coinfection were considered for inclusion in the study. The frequency of HIV testing (to determine HIV load and CD4 + cell count) performed during the first year of therapy was compared with the frequency of HBV measurements (to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load), abdominal ultrasound examination, and measurement of levels of α-fetoprotein in serum. Results. HBV load data were obtained for only 16% of patients before initiation of antiretroviral therapy (ART), whereas HIV load was determined for 99% of patients before initiation of ART. The total number of HIV load measurements obtained during the first year after ART initiation was 497 (median number of HIV load measurements per patient, 3.0), compared with 85 measurements of HBV load (median number of HBV load measurements per patient, <1; P < .001). The percentage of patients who received any level of HBV monitoring (i.e., tests to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load) after ART initiation increased from 7% in 1999 to 52% in 2001 (P < .001), whereas the percentage of patients who underwent HIV load testing remained at 80%-90% during the same period. Conclusions. Health care providers treating patients with HIV infection during the period 1999-2003 infrequently monitored HBV response in coinfected patients, but they systematically monitored HIV response after ART initiation. Improved physician adherence to guidelines that better delineate HBV treatment and monitoring for patients with HIV-HBV coinfection is needed.
AB - Background. The common occurrence of hepatitis B virus (HBV) infection in patients who carry the human immunodeficiency virus (HIV) demands that both viruses be recognized, evaluated, and treated when appropriate. Methods. We identified 357 HIV- and hepatitis B surface antigen-positive patients who underwent testing from 1999 to 2003; 155 patients who were new to our clinic and who initiated therapy for HIV and HBV coinfection were considered for inclusion in the study. The frequency of HIV testing (to determine HIV load and CD4 + cell count) performed during the first year of therapy was compared with the frequency of HBV measurements (to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load), abdominal ultrasound examination, and measurement of levels of α-fetoprotein in serum. Results. HBV load data were obtained for only 16% of patients before initiation of antiretroviral therapy (ART), whereas HIV load was determined for 99% of patients before initiation of ART. The total number of HIV load measurements obtained during the first year after ART initiation was 497 (median number of HIV load measurements per patient, 3.0), compared with 85 measurements of HBV load (median number of HBV load measurements per patient, <1; P < .001). The percentage of patients who received any level of HBV monitoring (i.e., tests to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load) after ART initiation increased from 7% in 1999 to 52% in 2001 (P < .001), whereas the percentage of patients who underwent HIV load testing remained at 80%-90% during the same period. Conclusions. Health care providers treating patients with HIV infection during the period 1999-2003 infrequently monitored HBV response in coinfected patients, but they systematically monitored HIV response after ART initiation. Improved physician adherence to guidelines that better delineate HBV treatment and monitoring for patients with HIV-HBV coinfection is needed.
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U2 - 10.1086/512367
DO - 10.1086/512367
M3 - Article
C2 - 17342656
AN - SCOPUS:33947415368
SN - 1058-4838
VL - 44
SP - 996
EP - 1000
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -