title: Risk of End-Stage Liver Disease in HIV-Viral Hepatitis Coinfected Persons in North America From the Early to Modern Antiretroviral Therapy Eras.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: McGill University Health Centre, Montreal, Quebec, Canada.
authors: Marina B
authors: MB
authors: Klein
authors: Johns Hopkins University, Baltimore, Maryland.
authors: Keri N
authors: KN
authors: Althoff
authors: Johns Hopkins University, Baltimore, Maryland.
authors: Yuezhou
authors: Y
authors: Jing
authors: Johns Hopkins University, Baltimore, Maryland.
authors: Bryan
authors: B
authors: Lau
authors: University of Washington, Seattle.
authors: Mari
authors: M
authors: Kitahata
authors: University of Pennsylvania, Philadelphia.
authors: Vincent
authors: V
authors: Lo Re
authors: Johns Hopkins University, Baltimore, Maryland.
authors: Gregory D
authors: GD
authors: Kirk
authors: British Columbia Centre for Excellence in HIV/AIDS and University of British Columbia, Vancouver, Canada.
authors: Mark
authors: M
authors: Hull
authors: University of Washington, Seattle.
authors: H Nina
authors: HN
authors: Kim
authors: McGill University Health Centre, Montreal, Quebec, Canada.
authors: Giada
authors: G
authors: Sebastiani
authors: McGill University Health Centre, Montreal, Quebec, Canada.
authors: Erica E M
authors: EE
authors: Moodie
authors: Kaiser Permanente Northern California, Oakland.
authors: Michael J
authors: MJ
authors: Silverberg
authors: Vanderbilt University, Nashville, Tennessee.
authors: Timothy R
authors: TR
authors: Sterling
authors: Johns Hopkins University, Baltimore, Maryland.
authors: Jennifer E
authors: JE
authors: Thorne
authors: Northern Ontario School of Medicine, Sudbury, Canada.
authors: Angela
authors: A
authors: Cescon
authors: University of North Carolina, Chapel Hill.
authors: Sonia
authors: S
authors: Napravnik
authors: University of North Carolina, Chapel Hill.
authors: Joe
authors: J
authors: Eron
authors: University of Calgary, Alberta, Canada.
authors: M John
authors: MJ
authors: Gill
authors: Yale University and the Veterans Affairs Connecticut Healthcare System, New Haven.
authors: Amy
authors: A
authors: Justice
authors: University of California at San Francisco, California.
authors: Marion G
authors: MG
authors: Peters
authors: National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors: James J
authors: JJ
authors: Goedert
authors: Retrovirus Research Center, Universidad Central del Caribe, Bayamon, Puerto Rico.
authors: Angel
authors: A
authors: Mayor
authors: Johns Hopkins University, Baltimore, Maryland.
authors: Chloe L
authors: CL
authors: Thio
authors: University of California at San Diego, La Jolla.
authors: Edward R
authors: ER
authors: Cachay
authors: Johns Hopkins University, Baltimore, Maryland.
authors: Richard
authors: R
authors: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D060085:Coinfection; D058625:End Stage Liver Disease / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; coinfection; end-stage liver disease; hepatitis B virus; hepatitis C virus