1 University of Pennsylvania, Philadelphia, PA, USA.
2 Johns Hopkins University, Baltimore, MD, USA.
3 University of Washington, Seattle, WA, USA.
4 Yale University, New Haven, CT, USA.
5 Kaiser Permanente Northern California, Oakland, CA, USA.
6 Retrovirus Research Center, Universidad Central del Caribe, Bayamon, Puerto Rico.
7 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
8 University of California at San Diego, La Jolla, CA, USA.
9 British Columbia Centre for Excellence in HIV/AIDS and University of British Columbia, Vancouver, Canada.
10 University of Calgary, Calgary, Alberta, Canada.
11 Vanderbilt University Medical Center, Nashville, TN, USA.
12 Philadelphia Field Initiating Group for HIV Trials, Philadelphia, PA, USA.
13 University of California San Francisco, San Francisco, CA, USA.
14 McGill University Health Centre, Montreal, Quebec, Canada.
Hepatitis B virus (HBV) infection is a leading cause of end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) in HIV. Factors contributing to the high rates of liver complications among HIV/HBV-coinfected individuals remain unknown.
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) METHODS:: We performed a retrospective cohort study among HIV/HBV-coinfected patients in ten US and Canadian cohorts of the NA-ACCORD that validated ESLD (ascites, spontaneous bacterial peritonitis, variceal hemorrhage, and/or hepatic encephalopathy) and HCC diagnoses from 1996-2010. Multivariable Cox regression was used to examine adjusted hazard ratios (aHRs with 95% CIs) of liver complications (first occurrence of ESLD or HCC) associated with hypothesized determinants and with increasing durations of HIV suppression (≤500 copies/mL).
Among 3,573 HIV/HBV patients with 13,790 person-years of follow-up, 111 liver complications occurred (incidence rate=8.0 [95% CI, 6.6-9.7] events/1,000 person-years). Rates of liver complication were increased with non-black/non-Hispanic race (aHR=1.76 [1.13-2.74]), diabetes (aHR=2.07 [1.20-3.57]), lower time-updated CD4 cell count (<200 cells/mm: aHR=2.59 [1.36-4.91]; 201-499 cells/mm: aHR=1.75 [1.01-3.06] versus ≥500 cells/mm), heavy alcohol use (aHR=1.58 [1.04-2.39]), and higher FIB-4 at start of follow-up (>3.25: aHR=9.79 [5.73-16.74]; 1.45-3.25: aHR=3.20 [1.87-5.47] versus FIB-4 <1.45). HIV suppression for ≥6 months was associated with lower liver complication rates compared with those with unsuppressed HIV (aHR=0.56 [0.35-0.91]).
Non-black/non-Hispanic race, diabetes, lower CD4 cell count, heavy alcohol use, and advanced liver fibrosis were determinants of liver complications among HIV/HBV patients. Sustained HIV suppression should be a focus for HIV/HBV-coinfected patients to reduce the risks of ESLD/HCC.