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Clin Infect Dis. 2016 Nov 1;63(9):1160-1167. Epub 2016 Aug 9.

Risk of End-Stage Liver Disease in HIV-Viral Hepatitis Coinfected Persons in North America From the Early to Modern Antiretroviral Therapy Eras.

Author information

1
McGill University Health Centre, Montreal, Quebec, Canada.
2
Johns Hopkins University, Baltimore, Maryland.
3
University of Washington, Seattle.
4
University of Pennsylvania, Philadelphia.
5
British Columbia Centre for Excellence in HIV/AIDS and University of British Columbia, Vancouver, Canada.
6
Kaiser Permanente Northern California, Oakland.
7
Vanderbilt University, Nashville, Tennessee.
8
Northern Ontario School of Medicine, Sudbury, Canada.
9
University of North Carolina, Chapel Hill.
10
University of Calgary, Alberta, Canada.
11
Yale University and the Veterans Affairs Connecticut Healthcare System, New Haven.
12
University of California at San Francisco, California.
13
National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
14
Retrovirus Research Center, Universidad Central del Caribe, Bayamon, Puerto Rico.
15
University of California at San Diego, La Jolla.

Abstract

BACKGROUND:

 Human immunodeficiency virus (HIV)-infected patients coinfected with hepatitis B (HBV) and C (HCV) viruses are at increased risk of end-stage liver disease (ESLD). Whether modern antiretroviral therapy has reduced ESLD risk is unknown.

METHODS:

 Twelve clinical cohorts in the United States and Canada participating in the North American AIDS Cohort Collaboration on Research and Design validated ESLD events from 1996 to 2010. ESLD incidence rates and rate ratios according to hepatitis status adjusted for age, sex, race, cohort, time-updated CD4 cell count and HIV RNA were estimated in calendar periods corresponding to major changes in antiretroviral therapy: early (1996-2000), middle (2001-2005), and modern (2006-2010) eras.

RESULTS:

 Among 34 119 HIV-infected adults followed for 129 818 person-years, 380 incident ESLD outcomes occurred. ESLD incidence (per 1000 person-years) was highest in triply infected (11.57) followed by HBV- (8.72) and HCV- (6.10) coinfected vs 1.27 in HIV-monoinfected patients. Adjusted incidence rate ratios (95% confidence intervals) comparing the modern to the early antiretroviral era were 0.95 (.61-1.47) for HCV, 0.95 (.40-2.26) for HBV, and 1.52 (.46-5.02) for triply infected patients. Use of antiretrovirals dually activity against HBV increased over time. However, in the modern era, 35% of HBV-coinfected patients were not receiving tenofovir. There was little use of HCV therapy.

CONCLUSIONS:

 Despite increasing use of antiretrovirals, no clear reduction in ESLD risk was observed over 15 years. Treatment with direct-acting antivirals for HCV and wider use of tenofovir-based regimens for HBV should be prioritized for coinfected patients.

KEYWORDS:

HIV; coinfection; end-stage liver disease; hepatitis B virus; hepatitis C virus

PMID:
27506682
PMCID:
PMC5064164
DOI:
10.1093/cid/ciw531
[Indexed for MEDLINE]
Free PMC Article

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