title: HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010-12: a retrospective observational cohort study.
abstract: BACKGROUND
  Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China.
  
  
  METHODS
  We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010-11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care.
  
  
  RESULTS
  33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53-2·37) and HCV co-infection (1·46, 1·25-1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89-1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02-1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80-1·10) or HCV co-infection (1·10, 0·97-1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16-1·62) and HCV co-infection (1·30, 1·17-1·45), but not HBV co-infection (0·93, 0·82-1·05), than among those with HIV only.
  
  
  CONCLUSIONS
  Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression.
  
  
  BACKGROUND
  The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China; First Affiliated Hospital of China Medical University, Liaoning, China.
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhu
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yasong
authors.initials: Y
authors.lastname: Wu
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Dou
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China; Association of Schools and Programs of Public Health, Washington, DC, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Kleinman
authors.affiliation: Global AIDS Program, China Office, US Centers for Disease Control and Prevention, Beijing, China; Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, CA, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China.
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Ma
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China.
authors.forename: Decai
authors.initials: D
authors.lastname: Zhao
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Liu
authors.affiliation: National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Fang
authors.affiliation: First Affiliated Hospital of China Medical University, Liaoning, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, Guang Zhou Eighth People's Hospital, Guangdong, China.
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Cai
authors.affiliation: First Affiliated Hospital of China Medical University, Liaoning, China. Electronic address: hongshang100@hotmail.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Shang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents