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

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 (NA-ACCORD) Methods: We performed a retrospective cohort study among HIV/HBV-coinfected patients in ten US and Canadian cohorts of the NA-ACCORD that validated ESLD (ascites, spontaneous bacterial peritonitis, variceal hemorrhage, and/or hepatic encephalopathy) and HCC diagnoses from 1996-2010. Multivariable Cox regression was used to examine adjusted hazard ratios (aHRs with 95% 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 3,573 HIV/HBV patients with 13,790 person-years of follow-up, 111 liver complications occurred (incidence rate=8.0 [95% CI, 6.6-9.7] events/1,000 person-years). Rates of liver complication were increased with non-black/non-Hispanic race (aHR=1.76 [1.13-2.74]), diabetes (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.