Between January 2001 and April 2003, 169 HIV-1 infected patients started antiretroviral therapy. Two-thirds of patients were women (n=113). The median age was 35.0 years [interquartile range (IQR) 29.3–41.1]. Most patients were symptomatic for HIV (42% were at RAD001 mouse Centers for Disease Control and Prevention stage B and 44% were at stage C). The median CD4 count was 135 cells/μL (IQR 67–218) and median HIV-1 viral load was 5.3 log10 RNA copies/mL (IQR 4.7–5.6). Patients received either zidovudine, lamivudine and nevirapine (n=85) or stavudine, lamivudine and nevirapine (n=84). Seventeen patients (10.1%) had positive HBsAg results; one other patient (0.6%) had an indeterminate result. In a sub-set of 109 patients, antibodies
to hepatitis B core (anti-HBc) Selleck Saracatinib were found
in 89 patients (81.7%) and three other patients (2.8%) had indeterminate results. HBV DNA was detected in 14 of the 18 patients with positive or indeterminate HBsAg results [8.3% of the total study population, 95% confidence interval (CI) 4.6–13.5]. The positive predictive value of HBsAg was 76.5% (13 of 17 patients). The median HBV viral load in the 14 patients was 2.47 × 107 IU/mL (IQR 3680–1.59 × 108; range 270 to >2.2 × 108). The only patient with an indeterminate HBsAg result was found to be positive for anti-HBc and had an HBV viral load of 3680 IU/mL. Serology for HCV was positive in 28 patients (16.6%) and indeterminate in four other patients (2.4%). Twenty-one patients (12.4% of the total study population, 95% CI 7.9–18.4) were found with HCV RNA (all with positive HCV serology). Therefore, the positive predictive value of HCV serology was 75.0%. The median HCV viral load was 928 000 IU/mL (IQR 178 400–2.06 × 106; range 640–5.5 × 106). No patient was co-infected with HBV and HCV. Patients co-infected with HBV or HCV were comparable in most characteristics to those infected with HIV alone (Table 1). However, HCV co-infected patients were more likely to be older
and to have serum liver enzyme elevations. HBV co-infected patients had significant serum aspartate aminotransferase (AST) elevations PtdIns(3,4)P2 only. In multivariate analysis, HCV co-infection remained associated with greater age [≥45 years vs. <45 years, odds ratio (OR) 11.89, 95% CI 3.49–40.55, P<0.001] and abnormal serum alanine aminotransferase (ALT) level (≥1.25 × ULN vs. <1.25 × ULN, OR 7.81, 95% CI 1.54–39.66, P=0.01) but not with abnormal serum AST level (≥1.25 × ULN vs. <1.25 × ULN, OR 2.65, 95% CI 0.72–9.78, P=0.14). After adjustment for gender and serum ALT level, HBV co-infection was associated with abnormal serum AST level only (OR 4.33, 95% CI 1.32–14.17, P=0.02). In this study, we found high rates of active HBV and HCV co-infection in HIV-positive patients initiating antiretroviral therapy in Cameroon (8.3 and 12.4%, respectively). Most of these patients had high HBV or HCV viral load and moderate serum liver enzyme elevations.