Treatment outcomes of HIV patients with hepatitis B and C virus co-infections in Southwest China: an observational cohort study

Jingya Jia,Zhiyong Shen,Jing Li,Luojia Deng,Jinhui Zhu,Guanghua Lan,Jianjun Li,Han-Zhu Qian,Sten H Vermund,Huanhuan Chen,Qiuying Zhu,Hui Xing,Hui Lu,Andrew Johnson,Yuhua Ruan

doi:10.1186/s40249-021-00921-5

Abstract

BackgroundAntiretroviral therapy (ART) has reduced mortality among people living with HIV (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of ART. This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART.MethodsA retrospective cohort study analysis of 58 239 people living with HIV (PLWH) who initiated antiretroviral therapy (ART) during 2010–2018 was conducted in Guangxi Province, China. Data were from the observational database of the National Free Antiretroviral Treatment Program. Cox proportional hazard models were fitted to evaluate the effects of baseline infection of HBV or HCV or both on death and treatment attrition among PLWH.ResultsOur study showed high prevalence of HBV (11.5%), HCV (6.6%) and HBV-HCV (1.5%) co-infections. The overall mortality rate and treatment attrition rate was 2.95 [95% confidence interval (CI) 2.88–3.02] and 5.92 (95% CI 5.82–6.01) per 100 person-years, respectively. Compared with HIV-only patients, HBV-co-infected patients had 42% higher mortality [adjusted hazard ratio (aHR) = 1.42; 95% CI 1.32–1.54], HCV-co-infected patients had 65% higher mortality (aHR = 1.65; 95% CI 1.47–1.86), and patients with both HCV and HBV co-infections had 123% higher mortality (aHR = 2.23; 95% CI 1.87–2.66).ConclusionsHBV and HCV coinfection may have an additive effect on increasing the risk of all-cause death among PLWH who are on ART. It is suggested that there is need for primary prevention and access to effective hepatitis treatment for PLWH.Graphical

Highlights

Antiretroviral therapy (ART) has reduced mortality among people living with Human immunodeficiency virus (HIV) (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of antiretroviral therapy (ART)
12% died, 16% were lost to follow-up, 8% dropped out of treatment and 64% were active on treatment by the end of follow-up
The baseline characteristics of the study patients are shown in Table 1; 6,707 (11.5%) participants had HIVHBV co-infection, 3,828 (6.6%) had HIV-HCV co-infection, 857 (1.5%) and had triple infection

Summary

Introduction

Antiretroviral therapy (ART) has reduced mortality among people living with HIV (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of ART. This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART. Active antiretroviral therapy (ART) has reduced deaths among people living with HIV (PLWH) in China and globally [1,2,3]. Studies have shown that comorbid hepatitis B virus (HBV) and hepatitis C virus (HCV) infections could have negative impacts on HIV treatment outcomes, but few studies have assessed their individual and joint effects simultaneously [4,5,6]. Since some ART drugs have liver toxicity, coinfection of HBV and HCV is a significant risk factor for death in PLWH

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