Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono‐infection

• Published in: Liver international 2019-03, Vol.39 (3), p.470-483
• Main Authors: Lieveld, Faydra I., Smit, Colette, Richter, Clemens, van Erpecum, Karel J., Spanier, Bernhard W. M., Gisolf, Elisabeth H., Vrolijk, Jan M., Siersema, Peter D., Hoepelman, Andy I. M., Reiss, Peter, Arends, Joop E.
• Format: Article
• Language: English
• Subjects: Adult; Alanine; Alanine transaminase; Anti-Retroviral Agents - adverse effects; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Cirrhosis; Coinfection; Databases, Factual; Disease Progression; Drug Therapy, Combination; End Stage Liver Disease - diagnosis; End Stage Liver Disease - epidemiology; End Stage Liver Disease - mortality; End Stage Liver Disease - virology; end‐stage liver disease; Female; Hepatitis; Hepatitis B; Hepatitis B - diagnosis; Hepatitis B - epidemiology; Hepatitis B - mortality; hepatitis B virus; Hepatitis C; Hepatocellular carcinoma; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - mortality; Human immunodeficiency virus; Humans; Hypertension; Liver; Liver cirrhosis; liver decompensation; Liver diseases; Liver transplantation; Longitudinal Studies; Male; Middle Aged; Mortality; Netherlands - epidemiology; Patients; Regression analysis; Regression models; Retrospective Studies; Risk Assessment; Risk Factors; Statistical analysis; Tenofovir; Time dependence; Time Factors; Transplantation; Viruses
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.14000

Background & Aims HIV/hepatitis B virus (HBV) coinfected subjects are thought to have faster progression to end‐stage liver disease (ESLD) than HBV mono‐infected subjects. We assessed whether this remains in the current cART‐era. Methods Data from subjects with follow‐up completion post‐2003 were compared between HIV/HBV coinfected subjects in the Dutch HIV Monitoring database and HBV mono‐infected subjects from two centres. The primary outcomes of composite ESLD included portal hypertension, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver‐related mortality. Outcomes were analysed using time‐dependent cause‐specific Cox regression models adjusted for follow‐up time and relevant covariates. Subset‐analyses were done in subjects with follow‐up pre‐2003. Results In the 1336 co‐ vs 742 mono‐infected subjects, coinfected subjects had no increased probability for ESLD compared to mono‐infected subjects (cHR 0.7 (95% CI 0.4‐1.1), but had increased probabilities for all‐cause (cHR 7.4 [4.9‐11.1]) and liver‐related mortality (cHR 3.4 [1.6‐7.5]). In the current combined cohort, treatment with tenofovir or entecavir was inversely associated with ESLD, all‐cause and liver‐related mortality (cHR 0.4 [95% CI 0.3‐0.7], cHR 0.003 [0.001‐0.01]), cHR 0.007 [0.001‐0.05]). Other predictors for ESLD were older age, being of Sub‐Sahara African descent, increased alanine aminotransferase levels and hepatitis C virus coinfection. While the probability for all‐cause mortality was increased in coinfected subjects, this rate decreased compared to pre‐2003 (HR 40.2 (95% CI: 8.7‐186.2). Conclusions HIV/HBV coinfected patients no longer seem to be at increased risk for progression to ESLD compared to HBV mono‐infected patients, likely due to widespread use of highly effective cART with dual HBV and HIV activity.