To compare rates of all-cause, liver-related and AIDS-related mortality among individuals who are HIV mono-infected with those co-infected with HIV and hepatitis B (HBV) and/or hepatitis C (HCV) viruses.
An ongoing observational cohort study collating routinely collected clinical data on HIV-positive individuals attending for care at HIV treatment centres throughout the UK.
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 mono-infected individuals and those co-infected 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 co-infection on mortality in this cohort.
Among 25486 HIV-positive individuals, with a median follow up 4.5 years, HBV co-infection 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 co-infection 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 co-infection were associated with increased AIDS-related mortality: ARRs (95% CI) 1.07 (0.63-1.83) and 0.40 (0.20-0.81) respectively.
The increased rate of all-cause and liver-related mortality among hepatitis co-infected individuals in this HIV-positive cohort highlights the need for primary prevention and access to effective hepatitis treatment for HIV-positive individuals.