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Triple Trouble: Infection With Hepatitis B Increases Risk of Death for People with HIV and Hepatitis C Co-Infection

February 19, 2013

A Spanish research team reports that hepatitis B infection increases the risk of death by 75 percent for HIV/ hepatitis C-co-infected people. Earlier studies have focused on HIV/ hepatitis C co-infection or HIV/hepatitis B co-infection, but not the consequences of co-infection with all three viruses. Transmission is similar for HIV, hepatitis B, and hepatitis C.

The study analyzed data from the VACH cohort, comprised of 6,342 HIV/hepatitis C-infected individuals. Six percent of the VACH cohort also had hepatitis B. Study participants who had all three viruses were likely to be older, male, have a lower CD4 count, and higher AST-to-platelet index than cohort members co-infected only with HIV and hepatitis C.

VACH data provided almost 26,000 person-years of follow-up with a total of 543 deaths and an average mortality rate of 2.1 per 100 person years. In contrast, co-infection with all three viruses increased the mortality rate per 100 person years to 3.78. Researchers initially concluded that co-infection with hepatitis B increased the mortality rate by 90 percent, but they revised their estimate to 75 percent when they factored in AIDS-defining illness, age, HIV and hepatitis C treatment, CD4 cell count, and viral load. Factors that increased mortality risk for HIV/hepatitis B/hepatitis C co-infected people included "detectable" viral load and older age. Higher CD4 cell count, HIV treatment, and tenofovir treatment regimen (effective against HIV, hepatitis B, and hepatitis C) comprised factors associated with a better outcome.

The study also indicated that HIV/hepatitis B/hepatitis C co-infection increases the risk of liver disease-related death. Researchers strongly recommended hepatitis B immunization for HIV-infected people and people at risk of HIV infection.

The full article, "Hepatitis B Virus Infection Predicts Mortality of HIV and Hepatitis C Virus Co-infected Patients" was published online in the journal AIDS 27 (2013; doi:10.1097/QAD.0b013e32835ecaf7).

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