Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort

Highlights • We compared HBV monoinfection with HBV/coinfection in a cross-sectional cohort from South Africa. • HBV/HIV coinfected individuals were more likely to undergo assessment by fibroscan. • HBV monoinfection was less likely to be treated than HBV/HIV coinfection. • Indications of severe liver disease were more common in HBV monoinfection. • Cases of hepatocellular carcinoma all arose in HBV monoinfection. Objectives Prompted by international targets for elimination of hepatitis B virus (HBV), we set out to characterise individuals with HBV monoinfection vs. those coinfected with HBV/HIV, to evaluate the impact of therapy and to guide improvements in clinical care. Methods We report observational data from a real world cross-sectional cohort of 115 adults with chronic hepatitis B infection (CHB), at a university hospital in Cape Town, South Africa. HIV coinfection was present in 39 (34%) subjects. We recorded cross-sectional demographic, clinical and laboratory data. Results Compared to those with HIV coinfection, HBV monoinfected adults were less likely to be HBeAg-positive (p=0.01), less likely to have had assessment with elastography (p<0.0001), and less likely to be on antiviral treatment (p<0.0001); they were more likely to have detectable HBV viraemia (p=0.04), and more likely to have features of liver disease including moderate/severe thrombocytopaenia (p=0.007), elevated bilirubin (p=0.004), and elevated APRI score (p=0.02). Three cases of hepatocellular carcinoma all arose in HBV monoinfection. Conclusions Our data demonstrate that individuals with HBV monoinfection may be disadvantaged compared to those with HIV coinfection, highlighting potential systematic inequities in referral, monitoring and treatment.