Background: Hepatitis B (HBV) co-infection increases the risk for liver-related morbidity among HIV-infected patients. Department of Health and Human Services (DHHS) guidelines for the management of HIV/HBV co-infection recommend six-monthly monitoring of blood tests. We assessed longitudinal adherence to these guidelines among patients enrolled in the DC Cohort Study, a city-wide clinical cohort in Washington, DC.
Methods: Patients ≥18 years old who were enrolled between 1/1/2011 and 3/31/2016 and had ≥6 months of follow up were included. Advanced liver fibrosis was defined as having a FIB-4 score >3.25 calculated from same-day platelet, AST and ALT results. Viral suppression (VS) was defined as having undetectable HIV VL (<200 copies/mL). Chronic HBV status was determined using ICD 9 and 10 diagnosis codes. Clinical targets were defined as the proportion tested for HBV viral load (VL), platelet count and AST (markers of HBV care) along with HIV VL and CD4 count tests (markers of HIV care) every six months following enrollment.
Results: Among 7,631 HIV-infected patients, 354 (4.6%) had chronic HBV among whom 22 (6.2%) had advanced fibrosis. Compared to HIV-mono-infected patients, HIV/HBV patients were more likely to be male (86% vs 72%, p<0.001) and had a history of AIDS (49% vs 37%, p<0.001). Although HIV VS was high in both groups, co-infected patients were less likely to have undetectable HIV VL (88% in HIV only vs 84% in HIV/HBV, p=0.026). HIV/HBV patients were nearly four times less likely to be tested for HBV than for HIV VL in the 1st six months (21% vs 79%, p <0.0001) and eight times less likely in the last six months of observation (6% vs 49%, p <0.0001). Comparing the first six months to the last six months of observation, the proportion of patients tested for AST (77% and 50% p<0.0001) and platelets (76% and 57% p<0.0001) declined.
Conclusion: Adherence to the DHHS management guidelines for monitoring HBV VL among HIV/HBV co-infected patients was low. AST and platelet counts were monitored at a similar frequency to HIV VL, suggesting that these markers may have been checked as part of routine HIV care than for HBV monitoring. Focusing on adherence to guidelines may ensure early detection of complications and provide patients with timely and appropriate care.
M. Bryant, None
Q. Hou, None
S. S. Doshi, None