Determinants of Liver Complications among HIV/Hepatitis B Virus-Coinfected Patients

Vincent Lo Re; Craig W. Newcomb; Dena M. Carbonari; Jason A. Roy; Keri N. Althoff; Mari M. Kitahata; K. Rajender Reddy; Joseph K. Lim; Michael J. Silverberg; Angel M. Mayor; Michael A. Horberg; Edward R. Cachay; Gregory D. Kirk; Mark Hull; John Gill; Timothy R. Sterling; Jay R. Kostman; Marion G. Peters; Richard D. Moore; Marina B. Klein; H. Nina Kim

doi:10.1097/QAI.0000000000002094

Determinants of Liver Complications among HIV/Hepatitis B Virus-Coinfected Patients

Vincent Lo Re, Craig W. Newcomb, Dena M. Carbonari, Jason A. Roy, Keri N. Althoff, Mari M. Kitahata, K. Rajender Reddy, Joseph K. Lim, Michael J. Silverberg, Angel M. Mayor, Michael A. Horberg, Edward R. Cachay, Gregory D. Kirk, Mark Hull, John Gill, Timothy R. Sterling, Jay R. Kostman, Marion G. Peters, Richard D. Moore, Marina B. KleinH. Nina Kim

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

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.

Original language	English (US)
Pages (from-to)	71-80
Number of pages	10
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	82
Issue number	1
DOIs	https://doi.org/10.1097/QAI.0000000000002094
State	Published - Sep 1 2019

Keywords

HIV
coinfection
end-stage liver disease
hepatitis B
hepatocellular carcinoma

ASJC Scopus subject areas

Infectious Diseases
Pharmacology (medical)

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10.1097/QAI.0000000000002094

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Lo Re, V., Newcomb, C. W., Carbonari, D. M., Roy, J. A., Althoff, K. N., Kitahata, M. M., Reddy, K. R., Lim, J. K., Silverberg, M. J., Mayor, A. M., Horberg, M. A., Cachay, E. R., Kirk, G. D., Hull, M., Gill, J., Sterling, T. R., Kostman, J. R., Peters, M. G., Moore, R. D., ... Kim, H. N. (2019). Determinants of Liver Complications among HIV/Hepatitis B Virus-Coinfected Patients. Journal of Acquired Immune Deficiency Syndromes, 82(1), 71-80. https://doi.org/10.1097/QAI.0000000000002094

Lo Re, V, Newcomb, CW, Carbonari, DM, Roy, JA, Althoff, KN, Kitahata, MM, Reddy, KR, Lim, JK, Silverberg, MJ, Mayor, AM, Horberg, MA, Cachay, ER, Kirk, GD, Hull, M, Gill, J, Sterling, TR, Kostman, JR, Peters, MG, Moore, RD, Klein, MB & Kim, HN 2019, 'Determinants of Liver Complications among HIV/Hepatitis B Virus-Coinfected Patients', Journal of Acquired Immune Deficiency Syndromes, vol. 82, no. 1, pp. 71-80. https://doi.org/10.1097/QAI.0000000000002094

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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 = "Publisher Copyright: Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.",

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",

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TY - JOUR

T1 - Determinants of Liver Complications among HIV/Hepatitis B Virus-Coinfected Patients

AU - Lo Re, Vincent

AU - Newcomb, Craig W.

AU - Carbonari, Dena M.

AU - Roy, Jason A.

AU - Althoff, Keri N.

AU - Kitahata, Mari M.

AU - Reddy, K. Rajender

AU - Lim, Joseph K.

AU - Silverberg, Michael J.

AU - Mayor, Angel M.

AU - Horberg, Michael A.

AU - Cachay, Edward R.

AU - Kirk, Gregory D.

AU - Hull, Mark

AU - Gill, John

AU - Sterling, Timothy R.

AU - Kostman, Jay R.

AU - Peters, Marion G.

AU - Moore, Richard D.

AU - Klein, Marina B.

AU - Kim, H. Nina

PY - 2019/9/1

Y1 - 2019/9/1

N2 - 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.

AB - 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.

KW - HIV

KW - coinfection

KW - end-stage liver disease

KW - hepatitis B

KW - hepatocellular carcinoma

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Determinants of Liver Complications among HIV/Hepatitis B Virus-Coinfected Patients

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