Long-term effect of chronic hepatitis B on mortality in HIV-infected persons in a differential HBV transmission setting

• Authors: Justine Umutesi, Helmholtz Centre for Infection Research (HZI); Sabin Nsanzimana, Rwanda Biomedical Center; Carol Yingkai Liu, Emory University; Patrizio Vanella, Helmholtz Centre for Infection Research (HZI); Jördis J Ott, Helmholtz Centre for Infection Research (HZI); Gérard Krause, Helmholtz Centre for Infection Research (HZI)
• Journal Title: BMC Infectious Diseases
• Volume: Volume 22, Number 1
• Publisher: BioMed Central Ltd | 2022-12-01, Pages 500-500
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s12879-022-07477-1
• Subjects: Health Sciences, Epidemiology
• Keywords: Chronic hepatitis B; Cohort study; HIV; Mortality; Rwanda; Sub-Saharan Africa; Adult; Coinfection; HIV Infections; Hepatitis B Surface Antigens; Hepatitis B virus; Hepatitis B, Chronic; Humans; Male; Rwanda

Abstract

Background: There remain gaps in quantifying mortality risk among individuals co-infected with chronic hepatitis B (HBV) and human immunodeficiency virus (HIV) in sub-Saharan African contexts. Among a cohort of HIV-positive individuals in Rwanda, we estimate the difference in time-to mortality between HBV-positive (HIV/HBV co-infected) and HBV-negative (HIV mono-infected) individuals. Methods: Using a dataset of HIV-infected adults screened for hepatitis B surface antigen (HBsAg) from January to June 2016 in Rwanda, we performed time-to-event analysis from the date of HBsAg results until death or end of study (31 December 2019). We used the Kaplan–Meier method to estimate probability of survival over time and Cox proportional hazard models to adjust for other factors associated with mortality. Results: Of 21,105 available entries, 18,459 (87.5%) met the inclusion criteria. Mean age was 42.3 years (SD = 11.4) and 394 (2.1%) died during follow-up (mortality rate = 45.7 per 100,000 person-months, 95% confidence interval (CI) 41.4–50.4) Mortality rate ratio for co-infection was 1.7, 95% CI 1.1–2.6, however, Cox regression analysis did not show any association with mortality between compared groups. The adjusted analysis of covariates stratified by co-infection status showed that males, residing outside of the capital Kigali, drinking alcohol, WHO-HIV-clinical stage 3 and 4 were associated with increased mortality in this HIV cohort. Conclusions: HBV infection does not significantly influence mortality among HIV-infected individuals in Rwanda. The current cohort is likely to have survived a period of high-risk exposure to HBV and HIV mortality and limited health care until their diagnosis.