Saturday, September 29, 2012

Risk for liver-related death higher with chronic HBV than HCV

Risk for liver-related death higher with chronic HBV than HCV

Falade-Nwulia O. Clin Infect Dis. 2012;55:507-513.

  • September 27, 2012
Patients with chronic HBV were at a greater risk for liver-related death than patients with chronic HCV, particularly among those with HIV coinfection, in a recent study.

Researchers evaluated 337 male patients with chronic HBV and 343 with chronic HCV, along with a subgroup of 472 patients coinfected with HIV-1, during 6,728 person-years. All participants had been members of the Multicenter AIDS Cohort Study (MACS). Incidence and causes of death were recorded, and mortality rates due to liver-related issues and all causes were calculated and compared between the groups.

Death from any cause occurred in 293 cases (43.5 per 1,000 person-years), including 51 because of liver-related issues (7.6 per 1,000 person-years). Most liver-related deaths (90.2%) occurred among patients coinfected with HIV, with mortality rates of 10.7 per 1,000 person-years among coinfected patients compared with 2.1 among those without HIV (P<.001).

All-cause mortality rates were similar between the two groups (41.2 per 1,000 person-years in the HBV group and 46.4 per 1,000 person-years in the HCV group, P=.5 for difference), but liver-related death was more common in the HBV group (9.6 per 1,000 person-years compared with 5.0, P=.027).

In the HIV coinfected subgroup, multivariate analysis indicated that liver-related death was more common among patients with HBV than those with HCV after adjusting for both potential confounders (IRR=2.2; 95% CI, 1.1-4.5) and competing risks (subhazard rate ratio=2.4; 95% CI, 1.14-5.04). Coinfected patients with CD4 cell counts less than 200 cells/mm3 (IRR=16.2; 95% CI, 6.1-42.8) and counts between 200 and 350 cells/mm3 (IRR=7.0; 95% CI, 2.4-20.1) were at significantly greater risk for liver-related death than those with counts more than 350. Older age also was associated with liver-related death in this subgroup (IRR=1.6; 95% CI, 1.1-2.3 per 10 years).

“This study clearly demonstrates that [chronic HBV] carries a greater risk of death from liver disease than does [chronic HCV],” the researchers wrote. “More emphasis needs to be placed on more-effective global HBV screening and increased efforts for vaccination and treatment of HBV infection worldwide.”

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