Hepatitis B, hepatitis C, and mortality among HIV-positive individuals

Abstract

Objectives:To compare rates of all-cause, liver-related, and AIDS-related mortality among individuals who are HIV-monoinfected with those coinfected with HIV and hepatitis B (HBV) and/or hepatitis C (HCV) viruses.Design:An ongoing observational cohort study collating routinely collected clinical data on HIV-positive individuals attending for care at HIV treatment centres throughout the United Kingdom.Methods:Individuals were included if they had been seen for care from 2004 onwards and had tested for HBV and HCV. Crude mortality rates (all cause, liver related, and AIDS related) were calculated among HIV-monoinfected individuals and those coinfected with HIV, HBV, and/or HCV. Poisson regression was used to adjust for confounding factors, identify independent predictors of mortality, and estimate the impact of hepatitis coinfection on mortality in this cohort.Results:Among 25 486 HIV-positive individuals, with a median follow-up 4.5 years, HBV coinfection was significantly associated with increased all-cause and liver-related mortality in multivariable analyses: adjusted rate ratios (ARR) [95% confidence intervals (95% CI)] were 1.60 (1.28–2.00) and 10.42 (5.78–18.80), respectively. HCV coinfection was significantly associated with increased all-cause (ARR 1.43, 95% CI 1.15–1.76) and liver-related mortality (ARR 6.20, 95% CI 3.31–11.60). Neither HBV nor HCV coinfection were associated with increased AIDS-related mortality: ARRs (95% CI) 1.07 (0.63–1.83) and 0.40 (0.20–0.81), respectively.Conclusion:The increased rate of all-cause and liver-related mortality among hepatitis-coinfected individuals in this HIV-positive cohort highlights the need for primary prevention and access to effective hepatitis treatment for HIV-positive individuals.

Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono‐infection

“…Moreover, in additionally performed Kaplan‐Meier survival analyses, where we compared all patients with and without HCV, we found that HCV‐infected patients had significantly higher probabilities of all‐cause mortality and liver‐related mortality, whereas probabilities for ESLD were the same. Previous studies showed that patients triply infected with HIV, HBV and HCV have significantly higher risk for liver‐related mortality in adjusted models when compared to double infections (HIV/HBV‐, HIV/HCV‐ or HBV/HCV co‐infection) …”

“…In the combined cohorts, those with liver-related mortality were aged older (median 44 [IQR 40-53] vs 37 [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] years, P < 0.0001), were more often male (46 [90%] vs 1558 [77%], P = 0.03), and had higher vs 43 , P < 0.0001) at baseline, compared to those without liver-related mortality. Moreover, they had higher incidences of HCV coinfection (8 [ In coinfected subjects, no difference in baseline HIV RNA was observed in those with liver-related mortality vs those with other causes of mortality, while significantly lower baseline CD4 counts (212 [130-420] vs 347 , P = 0.05) were observed in those with liver-related mortality.…”

Direct‐acting antiviral sustained virologic response: Impact on mortality in patients without advanced liver disease

“…This suggests that the mortality benefits of SVR in patients with synthetic dysfunction may be slightly lessened and serves as additional leverage for treating patients earlier in their HCV infection, prior to development of more advanced liver disease. From a population standpoint, in addition to the reduction in mortality, treating all patients with HCV regardless of stage of disease would also further reduce HCV transmission …”

“…From a population standpoint, in addition to the reduction in mortality, treating all patients with HCV regardless of stage of disease would also further reduce HCV transmission. (18,20,22,28,32) In this cohort, we compared patients who achieved SVR to both untreated patients and patients who were treated but did not achieve SVR, though the comparison between patients who achieved SVR and those who were treated and did not achieve SVR is the more relevant comparison to assess the mortality benefit of SVR with DAA treatment. Unlike many other health care providers and systems, in the VA there were minimal treatment restrictions, all patients were considered for treatment, and extensive outreach occurred to bring patients in for treatment.…”

Prevalence of diagnosed HIV infection among persons with hepatitis C virus infection: England, 2008–2014

“…HCV transmission has been linked to recreational drug use and high‐risk sexual behaviours . Coinfection with HCV and HIV leads to faster progression to advanced liver disease , and there is conflicting evidence as to whether coinfection worsens HIV‐associated outcomes, such as AIDS‐defining events and HIV‐associated mortality .…”