title: Chronic hepatitis B increases mortality and complexity among HIV-coinfected patients in South Africa: a cohort study.
abstract: To assess the effect of chronic hepatitis B on survival and clinical complexity among people living with HIV following antiretroviral therapy (ART) initiation.
  
  
  
  We evaluated mortality and single-drug substitutions up to 3 years from ART initiation (median follow-up 2.75 years; interquartile range 2-3 years) among patients with and without chronic hepatitis B (CHB) enrolled in a workplace HIV care programme in South Africa.
  
  
  
  Mortality was increased for CHB patients with hepatitis B virus (HBV) DNA levels > 10 000 copies/mL (adjusted hazard ratio 3.1; 95% confidence interval 1.2-8.0) compared with non-CHB patients. We did not observe a similar difference between non-CHB patients and those with CHB and HBV DNA < 10 000 copies/mL (adjusted hazard ratio 0.70; 95% confidence interval 0.2-2.3). Single-drug substitutions occurred more frequently among coinfected patients regardless of HBV DNA level.
  
  
  
  Our findings suggest that CHB may increase mortality and complicate ART management.
authors.affiliation: The Aurum Institute, Johannesburg, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Velen
authors.affiliation: The Aurum Institute, Johannesburg, South Africa.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Charalambous
authors.affiliation: The Aurum Institute, Johannesburg, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Innes
authors.affiliation: The Aurum Institute, Johannesburg, South Africa.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: G J
authors.initials: GJ
authors.lastname: Churchyard
authors.affiliation: The Aurum Institute, Johannesburg, South Africa.|Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: C J
authors.initials: CJ
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D000349:Africa; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D060085:Coinfection / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013019:South Africa / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents
keywords: Africa; HIV; antiretroviral therapy; hepatitis B; mortality