Hepatitis B virus genotype G and liver fibrosis progression during chronic hepatitis B and human immunodeficiency virus coinfection

Objectives. Infection with hepatitis B virus (HBV) genotype G has been associated with increased liver fibrosis levels compared to other genotypes in cross-sectional studies, yet its role in fibrosis evolution remains to be established. The aim of this study was to determine the effect of HBV genotype G on long-term liver fibrosis evolution in patients coinfected with human immunodeficiency virus (HIV) and HBV.

Methods. In this prospective cohort study, 158 HIV-HBV coinfected patients had available HBV genotyping at baseline. Liver fibrosis was assessed at baseline and every six to twelve months by the FibroTest®. Risk factors for fibrosis regression (F3-F4 to F0-F1-F2) and progression (F0-F1-F2 to F3-F4) between baseline and end of follow up were evaluated.

Results. Most patients were male (88.6%) with 39 years median age. HBV-genotype A was more prevalent compared to other HBV-genotypes (66.4% versus D, 4.9%; E, 10.5%, and G, 17.5%). Patients were followed a median 84 months (IQR=37-96). In the 43 (27.2%) patients with F3-F4 baseline liver fibrosis, 7/43(16.2%) regressed to F0-F1-F2 fibrosis at the last follow up visit. No association between HBV genotypes and fibrosis regression was observed. In the 115 (72.8%) with F0-F1-F2 fibrosis at baseline, 16 (16.5%) progressed to F3-F4 fibrosis at last visit. In multivariable analysis, liver fibrosis progression was independently associated with older age (p350/mm3 (p<0.01), longer duration of ART (p<0.03), and HBV-genotype G infection (versus non-G, p<0.01). When examining averages over time (Figure), rate of FibroTest® increase was consistently faster in genotype G versus non-G infected patients with baseline F0-F1-F2 fibrosis (p for interaction=0.002).

Conclusion. In HIV-HBV coinfected patients, HBV-genotype G is an independent risk factor for liver fibrosis progression as determined by non-invasive markers. HBV genotype G infected patients with low initial liver fibrosis levels may require more careful monitoring.

Vincenzo Malagnino
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