HBV coinfection is associated with reduced CD4 response to antiretroviral treatment in pregnancy

HIV Clin Trials. 2017 Mar;18(2):54-59. doi: 10.1080/15284336.2016.1276312. Epub 2017 Jan 9.


Objective: To evaluate the impact of Hepatitis B virus (HBV) coinfection on response to antiretroviral treatment in pregnant women with HIV.

Methods: Retrospective analysis of a large case series of pregnant women with HIV in Italy; outcome measures were CD4 changes, HIV viral load, and main pregnancy outcomes (preterm delivery, low birthweight, intrauterine growth restriction, mode of delivery, and major birth defects).

Results: Rate of HBV coinfection among 1462 pregnancies was 12.0%. Compared to the HBV-uninfected, HBV-coinfected women had a significantly lower median CD4 cell gain between first and third trimester (26.5 vs. 60 cells/mm3, p = 0.034), with similar rate of undetectable (<50 copies/ml) HIV-RNA at third trimester (70.5% vs. 65.2%, p = 0.229), and no differences in all the main maternal and infant outcomes. A multivariable linear regression analysis identified four variables significantly and independently associated with a lower CD4 response in pregnancy: HBV coinfection (-35 cells/mm3), being on antiretroviral treatment at conception (-59.7 cells/mm3), AIDS status (-59.8 cells/mm3) and higher first CD4 levels in pregnancy (-0.24 cells per unitary CD4 increase).

Conclusions: HBV coinfection had no adverse influence on the main pregnancy outcomes or on HIV viral load suppression in late pregnancy but was associated with a significantly reduced CD4 response in pregnancy. This effect might have clinical relevance, particularly in women with advanced immune deterioration.

Keywords: Antiretroviral treatment; CD4 response; HBV; HIV; HIV viral load; Pregnancy; Pregnancy outcomes; Preterm delivery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / immunology*
  • CD4-Positive T-Lymphocytes / metabolism
  • Coinfection*
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / immunology*
  • HIV Infections / virology
  • Hepatitis B / epidemiology
  • Hepatitis B / immunology*
  • Hepatitis B virus / immunology
  • Humans
  • Infant
  • Italy / epidemiology
  • Odds Ratio
  • Pregnancy
  • Pregnancy Outcome
  • Treatment Outcome
  • Viral Load