Patients with HIV coinfected with hepatitis B (HBV) or hepatitis C (HCV) have a significantly greater risk of all-cause or liver-related mortality than those individuals who are HIV mono-infected, a study in AIDS reports.
Alicia C. Thornton, PhD, of the Research Department of Infection and Population Health at University College London in the UK, and colleagues compared all-cause, liver-related, and AIDS-related mortality rates in mono-infected HIV patients with those rates in co-infected HBV and HCV patients.
A total of 25,486 HIV patients across 11 UK-based clinics were tested for HBV using a hepatitis B surface antigen (HBsAg) test and HCV using an antibody or HCV RNA test. Causes of death were labeled liver-related, AIDS-related, or neither (all-cause). Liver-related death was defined as death due to decompensated liver disease, hepatocellular carcinoma and liver failure, and metastasized liver cancers.
Patients were categorized in AIDS-related deaths if AIDS was stated as a cause of death or if the cause of death included AIDS-defining illnesses (using the list of conditions from the CDC).
Of the patients who were HIV-positive before 2004 (121,814 person-years), 4.2% died during their follow-up time (median follow-up time was 4.6 years per person). Once test results were received, patients were grouped as HIV-monoinfected (89%), HIV/HBV-coinfected (47%), HIV/HCV-coinfected (5.5%), or HIV/HBV/HCV-triple-infected (0.49%).
The researchers found that all categories of hepatitis-coinfection are significantly associated with an increased risk of all-cause mortality, namely patients with triple infection, who have a 2.29 times greater risk of death than HIV-monoinfected patients. Also significant, HIV/HBV patients (ARR, 1.6) and HIV/HCV patients (ARR, 1.42) have a greater risk of death than HIV-monoinfected patients.
Liver-caused deaths were much more significant than all-cause rates in all three infection categories. Compared with HIV-monoinfection, the highest risk of mortality was associated with HIV/HBV/HCV (ARR, 15.19), followed by HIV/HBV (ARR, 10.42), and HIV/HCV (ARR, 6.2).
Hepatitis coinfection was not significantly involved in increasing mortality associated with AIDS, as HBV is not associated with an increase progression of HIV to AIDS. In addition, HIV/HCV-coinfected patients had a significantly lower risk of AIDS-related mortality compared with HIV-monoinfected patients (ARR, 0.4).
The findings emphasize the needs for primary prevention and effective hepatitis treatments for HIV-positive patients.
“Directly acting agents for treatment of HCV infection are now available, which have high rates of cure,” stated the authors. “If patients are able to access these treatments the increased risk of mortality from HCV infection may be mitigated.”
Thornton AC, Jose S, Bhagani S, et al. Hepatitis B, hepatitis C, and mortality among HIV-positive individuals. AIDS. 2017;31(18):2525-2532. doi: 10.1097/QAD.0000000000001646