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 journalArticlepeer-review


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 languageEnglish (US)
Pages (from-to)71-80
Number of pages10
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number1
StatePublished - Sep 1 2019


  • HIV
  • coinfection
  • end-stage liver disease
  • hepatitis B
  • hepatocellular carcinoma

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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