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Determinants of Liver Complications Among HIV/Hepatitis B Virus-Coinfected Patients.
- Source :
-
Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2019 Sep 01; Vol. 82 (1), pp. 71-80. - Publication Year :
- 2019
-
Abstract
- Background: 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.<br />Setting: North American AIDS Cohort Collaboration on Research and Design.<br />Methods: We performed a retrospective cohort study among HIV/HBV-coinfected patients in 10 US and Canadian cohorts of the North American AIDS Cohort Collaboration on Research and Design that validated ESLD (ascites, spontaneous bacterial peritonitis, variceal hemorrhage, and/or hepatic encephalopathy) and HCC diagnoses from 1996 to 2010. Multivariable Cox regression was used to examine adjusted hazard ratios [aHRs with 95% confidence interval (CIs)] of liver complications (first occurrence of ESLD or HCC) associated with hypothesized determinants and with increasing durations of HIV suppression (≤500 copies/mL).<br />Results: Among 3573 HIV/HBV patients with 13,790 person-years of follow-up, 111 liver complications occurred (incidence rate = 8.0 [95% CI: 6.6 to 9.7] events/1000 person-years). Rates of liver complication were increased with non-black/non-Hispanic race [aHR = 1.76 (1.13-2.74)], diabetes mellitus [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)].<br />Conclusions: 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.
- Subjects :
- Adult
CD4 Lymphocyte Count
Canada
Carcinoma, Hepatocellular complications
Carcinoma, Hepatocellular epidemiology
End Stage Liver Disease complications
Esophageal and Gastric Varices
Female
Gastrointestinal Hemorrhage
Humans
Liver
Liver Cirrhosis complications
Liver Cirrhosis epidemiology
Liver Neoplasms complications
Liver Neoplasms epidemiology
Male
Middle Aged
Retrospective Studies
Risk Factors
United States
HIV Infections complications
HIV Infections epidemiology
Hepatitis B complications
Hepatitis B epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1944-7884
- Volume :
- 82
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of acquired immune deficiency syndromes (1999)
- Publication Type :
- Academic Journal
- Accession number :
- 31107304
- Full Text :
- https://doi.org/10.1097/QAI.0000000000002094