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Multicenter Study
. 2002 Dec 14;360(9349):1921-6.
doi: 10.1016/s0140-6736(02)11913-1.

HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS)

Chloe L Thio  1 , Eric C Seaberg, Richard Skolasky Jr, John Phair, Barbara Visscher, Alvaro Muñoz, David L Thomas; Multicenter AIDS Cohort Study
Affiliations
Multicenter Study

HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS)

Chloe L Thio et al. Lancet. .

Abstract

Background: Although coinfection with HIV-1 and hepatitis B virus (HBV) is common, few long-term studies on liver-disease mortality in coinfected people have been undertaken. Our aim was to examine liver-related mortality among people at risk for HIV-1 and HBV infections.

Methods: We used data from a multicentre, prospective cohort study to classify 5293 men who had sex with men, according to their HIV-1 antibody status, ascertained semiannually, and their hepatitis-B surface antigen status (HBsAg), which we ascertained at baseline. Mortality rates were estimated in terms of person-years and Poisson regression methods were used to test for significance of relative risks.

Findings: 326 (6%) men were HBsAg positive, of whom 213 (65%) were HIV-1 positive. Of the 4967 HBsAg negative men, 2346 (47%) were infected with HIV-1. The liver-related mortality rate was 1.1/1000 person years, and was higher in men with HIV-1 and HBsAg (14.2/1000) than in those with only HIV-1 infection (1.7/1000, p<0.001) or only HBsAg (0.8/1000, p<0.001). In coinfected individuals, the liver-related mortality rate was highest with lower nadir CD4+ cell counts and was twice as high after 1996, when highly active antiretroviral therapy (HAART) was introduced.

Interpretation: Individuals coinfected with HIV-1 and HBV, especially those with low CD4+ nadir counts, are at increased risk for liver-related mortality, underscoring the importance of prevention, identification, and comprehensive management of hepatitis B in people infected with HIV-1.

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