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

Abstract

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:

• HIV
• Pregnancy
• HBV
• CD4 response
• HIV viral load
• Antiretroviral treatment
• Preterm delivery
• Pregnancy outcomes

Acknowledgments

We thank Cosimo Polizzi and Alessandra Mattei of the Istituto Superiore di Sanità in Rome, Italy, for providing technical secretarial for this study. No compensation was received for this contribution.