Risk of End-Stage Liver Disease in HIV-Viral Hepatitis Coinfected Persons in North America From the Early to Modern Antiretroviral Therapy Eras. Klein, M. B., Althoff, K. N., Jing, Y., Lau, B., Kitahata, M., Lo Re, V., Kirk, G. D., Hull, M., Kim, H. N., Sebastiani, G., Moodie, E. E. M., Silverberg, M. J., Sterling, T. R., Thorne, J. E., Cescon, A., Napravnik, S., Eron, J., Gill, M. J., Justice, A., Peters, M. G., Goedert, J. J., Mayor, A., Thio, C. L., Cachay, E. R., Moore, R., North American AIDS Cohort Collaboration on Research, of IeDEA, D., North American AIDS Cohort Collaboration on Research, & of IeDEA, D. (. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 63(9):1160–1167, 2016.
doi  abstract   bibtex   
BACKGROUND: Human immunodeficiency virus (HIV)-infected patients coinfected with hepatitis B (HBV) and C (HCV) viruses are at increased risk of end-stage liver disease (ESLD). Whether modern antiretroviral therapy has reduced ESLD risk is unknown. METHODS: Twelve clinical cohorts in the United States and Canada participating in the North American AIDS Cohort Collaboration on Research and Design validated ESLD events from 1996 to 2010. ESLD incidence rates and rate ratios according to hepatitis status adjusted for age, sex, race, cohort, 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. RESULTS: Among 34 119 HIV-infected adults followed for 129 818 person-years, 380 incident ESLD outcomes occurred. ESLD incidence (per 1000 person-years) was highest in triply infected (11.57) followed by HBV- (8.72) and HCV- (6.10) coinfected vs 1.27 in HIV-monoinfected patients. Adjusted incidence rate ratios (95% confidence intervals) comparing the modern to the early antiretroviral era were 0.95 (.61-1.47) for HCV, 0.95 (.40-2.26) for HBV, and 1.52 (.46-5.02) for triply infected patients. Use of antiretrovirals dually activity against HBV increased over time. However, in the modern era, 35% of HBV-coinfected patients were not receiving tenofovir. There was little use of HCV therapy. CONCLUSIONS: 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 coinfected patients.
@article{klein_risk_2016,
	title = {Risk of {End}-{Stage} {Liver} {Disease} in {HIV}-{Viral} {Hepatitis} {Coinfected} {Persons} in {North} {America} {From} the {Early} to {Modern} {Antiretroviral} {Therapy} {Eras}},
	volume = {63},
	issn = {1537-6591},
	doi = {10.1093/cid/ciw531},
	abstract = {BACKGROUND: Human immunodeficiency virus (HIV)-infected patients coinfected with hepatitis B (HBV) and C (HCV) viruses are at increased risk of end-stage liver disease (ESLD). Whether modern antiretroviral therapy has reduced ESLD risk is unknown.
METHODS: Twelve clinical cohorts in the United States and Canada participating in the North American AIDS Cohort Collaboration on Research and Design validated ESLD events from 1996 to 2010. ESLD incidence rates and rate ratios according to hepatitis status adjusted for age, sex, race, cohort, 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.
RESULTS: Among 34 119 HIV-infected adults followed for 129 818 person-years, 380 incident ESLD outcomes occurred. ESLD incidence (per 1000 person-years) was highest in triply infected (11.57) followed by HBV- (8.72) and HCV- (6.10) coinfected vs 1.27 in HIV-monoinfected patients. Adjusted incidence rate ratios (95\% confidence intervals) comparing the modern to the early antiretroviral era were 0.95 (.61-1.47) for HCV, 0.95 (.40-2.26) for HBV, and 1.52 (.46-5.02) for triply infected patients. Use of antiretrovirals dually activity against HBV increased over time. However, in the modern era, 35\% of HBV-coinfected patients were not receiving tenofovir. There was little use of HCV therapy.
CONCLUSIONS: 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 coinfected patients.},
	language = {eng},
	number = {9},
	journal = {Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America},
	author = {Klein, Marina B. and Althoff, Keri N. and Jing, Yuezhou and Lau, Bryan and Kitahata, Mari and Lo Re, Vincent and Kirk, Gregory D. and Hull, Mark and Kim, H. Nina and Sebastiani, Giada and Moodie, Erica E. M. and Silverberg, Michael J. and Sterling, Timothy R. and Thorne, Jennifer E. and Cescon, Angela and Napravnik, Sonia and Eron, Joe and Gill, M. John and Justice, Amy and Peters, Marion G. and Goedert, James J. and Mayor, Angel and Thio, Chloe L. and Cachay, Edward R. and Moore, Richard and {North American AIDS Cohort Collaboration on Research and Design of IeDEA} and {North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA}},
	year = {2016},
	pmid = {27506682},
	pmcid = {PMC5064164},
	keywords = {Adult, Aged, Alcohol Drinking, Anti-HIV Agents, Canada, Cohort Studies, Coinfection, End Stage Liver Disease, Female, HIV, HIV Infections, Hepatitis B, Hepatitis C, Humans, Incidence, Male, Middle Aged, Risk Factors, United States, coinfection, end-stage liver disease, hepatitis B virus, hepatitis C virus},
	pages = {1160--1167},
}
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