Lancet Infect Dis

BackgroundHepatitis-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.MethodsWe did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010\u201311. 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.Findings33 861 patients with HIV met eligibility criteria. 2958 (8\ub77%) participants had HBV co-infection, 6149 (18\ub72%) had HCV co-infection, and 1114 (3\ub73%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1\ub790, 95% CI 1\ub753\u20132\ub737) and HCV co-infection (1\ub746, 1\ub725\u20131\ub770) than in those with HIV only, but not in those with HBV co-infection (1\ub706, 0\ub789\u20131\ub726). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1\ub726, 95% CI 1\ub702\u20131\ub756) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0\ub793, 0\ub780\u20131\ub710) or HCV co-infection (1\ub710, 0\ub797\u20131\ub726). 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\ub737, 95% CI 1\ub716\u20131\ub762) and HCV co-infection (1\ub730, 1\ub717\u20131\ub745), but not HBV co-infection (0\ub793, 0\ub782\u20131\ub705), than among those with HIV only.InterpretationScreening 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.FundingThe National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.20142018-07-18T00:00:00ZU2G PS001188/PS/NCHHSTP CDC HHS/United States25303841PMC6051428749