HIV-infected patients co-infected with Hepatitis B (HBV) and C (HCV) viruses are at increased risk of endstage liver disease (ESLD). Whether modern antiretroviral therapy has reduced ESLD risk is unknown.
Patients from 12 clinical cohorts in US and Canada participating in the North American AIDS Cohort Collaboration on Research and Design that validated ESLD events from Jan 1, 1996 to Dec 31, 2010 were included. ESLD incidence rates and rate ratios according to hepatitis status adjusted for age, sex, race, cohort and time-updated CD4 cell count and HIV RNA were estimated in calendar periods corresponding to major changes in antiretroviral therapy: early (1996-2000), middle (2001-2005), and modern (2006-2010) eras.
Among 34,119 HIV-infected adults followed for 129,818 person-years, 380 incident ESLD outcomes occurred. ESLD incidence (/1000 person-years) was highest in triply infected (11.57) followed by HBV (8.72) and HCV (6.10) co-infected vs. 1.27 in HIV mono-infected patients. Adjusted incidence rate ratios [95% confidence intervals] comparing the modern to the early antiretroviral era were: 0.95 [0.61-1.47] for HCV, 0.95 [0.40-2.26] for HBV and 1.52 [0.46-5.02] for triply infected patients. Use of antiretrovirals with dual activity against HBV increased over time. However, in the modern era 35% of HBV co-infected patients were not receiving tenofovir. There was little use of HCV therapy.
Despite increasing use of antiretrovirals, no clear reduction in ESLD risk was observed over 15 years. Treatment with direct acting antivirals for HCV and wider use of tenofovir-based regimens for HBV should be prioritized for co-infected patients.