HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010–12: a retrospective observational cohort study

Abstract

Summary Background Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China. Methods We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010–11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care. Findings 33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53–2·37) and HCV co-infection (1·46, 1·25–1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89–1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02–1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80–1·10) or HCV co-infection (1·10, 0·97–1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16–1·62) and HCV co-infection (1·30, 1·17–1·45), but not HBV co-infection (0·93, 0·82–1·05), than among those with HIV only. Interpretation Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression. Funding The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.

Multiple acquisitions of STIs: invitation to precision in clinical care and summons to intangibles in laboratory diagnosis

“…This finding is similar to rate of co-infection of HIV with gonorrhoea from Mumbai (11.7%) and Kenya (17%) [15,21]. Co-infection of HIV with HCV reported from Kolkata (7.35%) is almost similar to present study (10%) [22]; although a lower rate is documented from South India (2.2%) and China (3.3%) [23,24]. Present study did not encounter co-infection of HIV with HBV while studies from other parts of India have reported this co-infection ranging from 9 to 15.19% [22,23].…”

Hepatitis C Direct Acting Antiviral Therapies in a New York City HIV/AIDS Special Needs Plan: Uptake and Barriers

“…[1][2][3] HCV-related liver disease progression is accelerated in HIV + patients compared to HCV mono-infected patients, and liver decompensation and hepatocellular carcinoma (HCC) have emerged as leading causes of morbidity and mortality in many HIV + patient populations. 4,5 Until recently, HCV was an incurable chronic infection for most HIV + patients.…”

Liver fibrosis after antiretroviral therapy in a longitudinal cohort of sexually infected HIV patients in eastern China

“…All-cause mortality was also higher in HIV-infected patients with HBV and/or HCV coinfection(s) than in those with HIV only, although ART has generally increased life expectancy of HIV-infected patients (13). Nevertheless, little is known about the impact of ART on the development and progression of liver diseases among people living with HIV and AIDS (PLWHA) in China.…”