More Liver-related Death for HIV/HBV than HIV/HCV Coinfection in MACS Cohort

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HIV and Hepatitis.com Coverage of the

18th Conference on Retroviruses and

Opportunistic Infections (CROI 2011)

February 27 - March 2, 2011, Boston, MA

More Liver-related Death for HIV/HBV than HIV/HCV Coinfection in MACS Cohort

SUMMARY: HIV positive gay and bisexual men in the log-running Multicenter AIDS

Cohort Study (MACS) were significantly more likely to die of liver-related

causes than HIV negative participants, and those coinfected with hepatitis B

virus (HBV) had about double the risk of death than those with hepatitis C virus

(HCV) coinfection, according to a poster presented at the 18th Conference on

Retroviruses and Opportunistic Infection (CROI 2011) last week in Boston.

By Liz Highleyman

Since the advent of effective antiretroviral therapy (ART), liver disease has

become a leading cause of death among people with HIV. Over years or decades,

chronic HBV and HCV infection can progress to severe liver disease including

cirrhosis, liver cancer, and ultimately end-stage liver failure; evidence

indicates that this process may happen faster in HIV positive people.

Oluwaseun Falade-Nwulia from s Hopkins University and colleagues compared

rates of liver-related mortality between participants in the MACS cohort who

were infected with HBV or HCV.

MACS is an ongoing prospective study of the natural history and HIV treatment

outcomes of men who have sex with men (MSM) in Baltimore, Chicago, Pittsburgh

and Los Angeles. The study has enrolled approximately 7000 men, both HIV

positive participants and HIV negative control subjects.

Men in the present analysis had either chronic hepatitis B (HBsAg positive) or

chronic hepatitis C (HCV antibody and HCV RNA positive) at study entry; men with

both viruses were excluded.

A total of 680 men were included in the analysis. About 75% were white and the

median age was 35 years. Of these, 472 men (69%) were HIV positive, 337 had

chronic hepatitis B, and 343 had chronic hepatitis C; thus, 229 were HIV/HBV

coinfected and 243 were HIV/HCV coinfected.

Participants were followed for a median of 7 years (ranging from just 5 months

to 25 years). The researchers obtained causes of death from death certificates,

and compared rates of liver-related mortality and all-cause mortality in

HBV-infected and HCV-infected men, adjusting for potential confounding factors.

Results

There were a total of 51 liver-related deaths during 6249 person-years of

follow-up:

36 among people with HBV (10.3 deaths per 1000 person-years);

15 among people with HCV (5.5 deaths per 1000 person-years).

Liver-related mortality was about twice as high for the chronic hepatitis B

group than the chronic hepatitis C group, after adjusting for race/ethnicity,

age, HIV status, CD4 cell count, and alcohol use.

A majority of participants (46) who died from liver-related causes were HIV

positive.

The liver-related death rate was 14.5 per 1000 person-years in the HIV/HBV

coinfected group, compared with 8.0 per 1000 person-years in the HIV/HCV

coinfected group.

Among people with HIV, liver-related death remained about twice as high among

HIV/HBV compared with HIV/HCV coinfected men after adjusting for race/ethnicity,

age, CD4 count, alcohol use, and use of antiretroviral drugs active against HBV

(IRR 2.16).

A similar model, however, did not show any difference in all-cause mortality

between HIV/HBV and HIV/HCV coinfected participants (RR 1.06).

Among people with hepatitis B or HIV/HBV coinfection, liver-related mortality

rose between 1984-1996 and 1997-2002, but then fell during 2003-2010.

All-cause mortality decreased from the first to the second period, and fell

further from the second to third.

Use of antiretrovirals active against HBV as well as HIV did not independently

predict less liver-related death, though mortality did start to decline in 2003

when tenofovir (Viread) became widely available.

Lower CD4 cell count was associated with a significantly greater risk of

liver-related death.

" In this cohort of MSM, the majority of liver-related deaths were in

HIV-infected individuals, " the MACS investigators concluded. " Chronic HBV

infection was associated with a higher risk of liver-related death than was

chronic HCV infection in all subjects and in the HIV-infected subgroup. "

These results, they added, underscore the need for expansion of HBV screening,

vaccination to protect against HBV infection, and treatment of HIV/HBV

coinfected individuals with dually active drugs. "

Investigator affiliation: s Hopkins Univ School of Medicine, Baltimore, MD.

3/11/11

Reference

O Falade-Nwulia, E Seaberg, C Rinaldo, and others. Liver-related Mortality Risk

Is Greater from Chronic HBV than from Chronic HCV: MACS, 18th Conference on

Retroviruses and Opportunistic Infections (CROI 2011). Boston. February 27-March

2, 2011. Abstract 968.