Abstract
OBJECTIVES:
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.
DESIGN:
An ongoing observational cohort study collating routinely collected clinical data on HIV-positive individuals attending for care at HIV treatment centres throughout the UK.
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 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.
RESULTS:
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.
CONCLUSIONS:
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.