In a cohort of men who have sex with men, hepatitis B virus infection conferred a higher risk for liver-related mortality than did hepatitis C virus infection.
Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) can result in liver disease and complications such as cirrhosis, hepatocellular carcinoma, and death. These complications are more common in individuals who are coinfected with HIV, but whether risk for liver-related mortality is higher with one type of hepatitis than the other is unknown. To explore this issue, investigators examined outcomes in patients with chronic hepatitis B (CH-B) or chronic hepatitis C (CH-C) in the Multicenter AIDS Cohort Study, a large prospective study involving men who have sex with men.
The present analysis included 337 patients with CH-B and 343 with CH-C; approximately 70% in both groups were coinfected with HIV. Although all-cause mortality was similar between the two groups, the risk for liver-related death was twice as high in patients with CH-B as in those with CH-C (9.6 vs. 5.0/1000 person-years). Among HIV-infected patients, those with CD4-cell counts <200/mm3 had a 16-fold increased risk for liver-related death compared to those with counts >350/mm3. After the introduction of more effective anti-HBV drugs such as tenofovir, liver-related mortality decreased among HIV/HBV-coinfected patients, but the decline was not statistically significant.
Comment: The investigators adjusted for possible confounders, but because determining the time of virus acquisition was not possible, the finding of greater liver-related mortality among patients with CH-B than among those with CH-C could be related to differences in duration of infection. Nonetheless, this study highlights the importance of HBV diagnosis and treatment — and prevention through vaccination. The finding of increased liver-related mortality in patients with low CD4-cell counts supports early treatment of HIV in HBV-coinfected patients. Prevention, diagnosis, and treatment are particularly important in HIV-infected patients in areas of the world where HBV is endemic, such as Africa and Asia.
— Rajesh T. Gandhi, MD
Published in Journal Watch Infectious Diseases August 22, 2012
Citation(s):
The present analysis included 337 patients with CH-B and 343 with CH-C; approximately 70% in both groups were coinfected with HIV. Although all-cause mortality was similar between the two groups, the risk for liver-related death was twice as high in patients with CH-B as in those with CH-C (9.6 vs. 5.0/1000 person-years). Among HIV-infected patients, those with CD4-cell counts <200/mm3 had a 16-fold increased risk for liver-related death compared to those with counts >350/mm3. After the introduction of more effective anti-HBV drugs such as tenofovir, liver-related mortality decreased among HIV/HBV-coinfected patients, but the decline was not statistically significant.
Comment: The investigators adjusted for possible confounders, but because determining the time of virus acquisition was not possible, the finding of greater liver-related mortality among patients with CH-B than among those with CH-C could be related to differences in duration of infection. Nonetheless, this study highlights the importance of HBV diagnosis and treatment — and prevention through vaccination. The finding of increased liver-related mortality in patients with low CD4-cell counts supports early treatment of HIV in HBV-coinfected patients. Prevention, diagnosis, and treatment are particularly important in HIV-infected patients in areas of the world where HBV is endemic, such as Africa and Asia.
— Rajesh T. Gandhi, MD
Published in Journal Watch Infectious Diseases August 22, 2012
Citation(s):
Falade-Nwulia O et al. Comparative risk of liver-related mortality from chronic hepatitis B versus chronic hepatitis C virus infection. Clin Infect Dis 2012 Aug 15; 55:507.
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