title: HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS).
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. cthio@jhmi.edu
authors.forename: Chloe L
authors.initials: CL
authors.lastname: Thio
authors.forename: Eric C
authors.initials: EC
authors.lastname: Seaberg
authors.forename: Richard
authors.initials: R
authors.lastname: Skolasky
authors.forename: John
authors.initials: J
authors.lastname: Phair
authors.forename: Barbara
authors.initials: B
authors.lastname: Visscher
authors.forename: Alvaro
authors.initials: A
authors.lastname: Muñoz
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
mesh_terms: D000328:Adult; D015704:CD4 Antigens / Q000097:blood*; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D015497:HIV-1; D006509:Hepatitis B / Q000150:complications* / Q000401:mortality; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012307:Risk Factors
chemical_list: D015704:CD4 Antigens; D006514:Hepatitis B Surface Antigens