@article{65d9ba3aa3ff45ff83a98ec240192fb9,
title = "Determinants of Liver Complications among HIV/Hepatitis B Virus-Coinfected Patients",
abstract = "Background:Hepatitis B virus (HBV) infection is a leading cause of end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) in HIV. Factors contributing to the high rates of liver complications among HIV/HBV-coinfected individuals remain unknown.Setting:North American AIDS Cohort Collaboration on Research and Design.Methods:We performed a retrospective cohort study among HIV/HBV-coinfected patients in 10 US and Canadian cohorts of the North American AIDS Cohort Collaboration on Research and Design that validated ESLD (ascites, spontaneous bacterial peritonitis, variceal hemorrhage, and/or hepatic encephalopathy) and HCC diagnoses from 1996 to 2010. Multivariable Cox regression was used to examine adjusted hazard ratios [aHRs with 95% confidence interval (CIs)] of liver complications (first occurrence of ESLD or HCC) associated with hypothesized determinants and with increasing durations of HIV suppression (≤500 copies/mL).Results:Among 3573 HIV/HBV patients with 13,790 person-years of follow-up, 111 liver complications occurred (incidence rate = 8.0 [95% CI: 6.6 to 9.7] events/1000 person-years). Rates of liver complication were increased with non-black/non-Hispanic race [aHR = 1.76 (1.13-2.74)], diabetes mellitus [aHR = 2.07 (1.20-3.57)], lower time-updated CD4 cell count [<200 cells/mm3: aHR = 2.59 (1.36-4.91); 201-499 cells/mm3: aHR = 1.75 (1.01-3.06) versus ≥500 cells/mm3], heavy alcohol use [aHR = 1.58 (1.04-2.39)], and higher FIB-4 at start of follow-up [>3.25: aHR = 9.79 (5.73-16.74); 1.45-3.25: aHR = 3.20 (1.87-5.47) versus FIB-4 <1.45]. HIV suppression for ≥6 months was associated with lower liver complication rates compared with those with unsuppressed HIV [aHR = 0.56 (0.35-0.91)].Conclusions:Non-black/non-Hispanic race, diabetes, lower CD4 cell count, heavy alcohol use, and advanced liver fibrosis were determinants of liver complications among HIV/HBV patients. Sustained HIV suppression should be a focus for HIV/HBV-coinfected patients to reduce the risks of ESLD/HCC.",
keywords = "HIV, coinfection, end-stage liver disease, hepatitis B, hepatocellular carcinoma",
author = "{Lo Re}, Vincent and Newcomb, {Craig W.} and Carbonari, {Dena M.} and Roy, {Jason A.} and Althoff, {Keri N.} and Kitahata, {Mari M.} and Reddy, {K. Rajender} and Lim, {Joseph K.} and Silverberg, {Michael J.} and Mayor, {Angel M.} and Horberg, {Michael A.} and Cachay, {Edward R.} and Kirk, {Gregory D.} and Mark Hull and John Gill and Sterling, {Timothy R.} and Kostman, {Jay R.} and Peters, {Marion G.} and Moore, {Richard D.} and Klein, {Marina B.} and Kim, {H. Nina}",
note = "Funding Information: Supported by research grant funding from the National Institute of Allergy and Infectious Diseases (R21-AI124868 to V.L.R.). Support was provided to North American AIDS Cohort Collaboration on Research and Design via National Institutes of Health Grants U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01CA165937, R01DA011602, R01DA012568, R01 AG053100, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176; contracts CDC-200-2006-18797 and CDC-200-2015-63931 from the Centers for Disease Control and Prevention, USA; contract 90047713 from the Agency for Healthcare Research and Quality, USA; contract 90051652 from the Health Resources and Services Administration, USA; Grants CBR-86906, CBR-94036, HCP-97105 and TGF-96118 from the Canadian Institutes of Health Research, Canada; Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the National Cancer Institute, National Institute for Mental Health, and National Institute on Drug Abuse. Funding Information: K.N.A. reports personal fees from Trio Health, outside the submitted work. E.R.C. reports grants and other speaking bureau fees from Gilead and grants from Merck, outside the submitted work. J.G. reports personal fees from ViiV Healthcare, Merck, and Gilead, outside the submitted work. Dr. Hull reports advisory board honoraria from Merck, Gilead, and ViiV Healthcare, outside the submitted work. M.B.K. reports grants from Canadian Institutes of Health Research (CIHR), CIHR Canadian HIV Trials Network, and Fonds de Recherche du Qu{\'e}bec-Sant{\'e}/R{\'e}seau; investigator-initiated grants from Merck and ViiV Healthcare; and consulting fees from Gilead, ViiV Healthcare, Merck, and AbbVie, outside the submitted work. J.R.K. reports consulting fees from Gilead Sciences, outside the submitted work. J.K.L. reports grants (to Yale University) and consulting fees from Bristol-Myers Squibb, outside the submitted work. R.D.M. reports personal fees from Medscape, outside the submitted work. M.G.P. reports personal fees from Abbott, outside the submitted work. K.R.R. reports grants (to the University of Pennsylvania) from Gilead, Bristol-Myers Squibb, Abbvie, Vertex, Janssen, Conatus, Intercept, Mallinckrodt, and Merck; personal fees from Gilead, Abbvie, Vertex, Bristol-Myers Squibb, Janssen, Merck, Dova, and Shionogi, all outside the submitted work; and UptoDate-online educational material (with no patent) for which he receives royalties. M.J.S. reports grants from Merck and Gilead, outside the submitted work. The remaining authors have conflicts of interest to disclose. Publisher Copyright: Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",
year = "2019",
month = sep,
day = "1",
doi = "10.1097/QAI.0000000000002094",
language = "English (US)",
volume = "82",
pages = "71--80",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "1",
}