Disclosures: Butt reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
August 19, 2020
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Coinfection with HCV, HBV or HIV significantly raises mortality risk

Disclosures: Butt reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Concurrent infection with hepatitis C, hepatitis B or HIV is associated with high mortality risk — up to nine times higher among triple-infected patients compared with noninfected patients, a study showed.

Zahid A. Butt

“None of the previous studies on hepatitis C, hepatitis B or HIV infections evaluated the transition of infection status from no infection to coinfection and triple infection and the impact of this transition on mortality,” Zahid A. Butt, MBBS, MSc, PhD, assistant professor at the University of Waterloo’s School of Public Health and Health Systems, told Healio. “Therefore, keeping in view this gap, this study was conducted to demonstrate the incremental risk in mortality with each additional bloodborne viral infection. We also wanted to assess important factors related to mortality, such as ethnicity, alcohol use and chronic conditions, which were not available in other studies.”

Butt and colleagues used data from the BC Hepatitis Testers Cohort, which includes approximately 1.7 million individuals tested for HCV or HIV, or reported as having HCV, HIV or HBV from 1990 to 2015. According to the study, the researchers followed patients with HCV, HBV or HIV monoinfection, coinfections and triple infections from their negative status to date of death or through Dec. 31, 2016.

Study data showed that among 658,704 individuals tested for HCV, HBV and HIV, 33,804 (5.13%) died. Individuals triple infected with HCV, HBV and HIV were almost nine times more likely to die (HR = 8.9; 95% CI, 8.2-9.7) — the highest risk of mortality, followed by those with HCV and HIV (HR = 4.8; 95% CI, 4.4-5.1), HBV and HIV (HR = 4.1; 95% CI, 3.5-4.8), HCV and HBV (HR = 3.9; 95% CI, 3.7-4.2), and monoinfected patients with HCV (HR =2.6; 95% CI, 2.6-2.7), HBV (HR = 2.2; 95% CI, 2-2.3) and HIV (HR = 1.6; 95% CI, 1.5-1.7).

According to Butt, the study showed that injection drug use, problematic alcohol use, comorbidities and material disadvantage were significantly associated with all-cause mortality independent of coinfection.

“Findings from this study identify areas of interventions for reducing mortality by preventing infection or managing infection with highly effective curative or suppressive therapies for HCV, HBV and HIV. Interventions addressing addictions and other comorbidities, in addition to prevention and management of infections, could provide additional benefit,” Butt said. “Within this context, multi-disease health screening for related chronic conditions, and colocation of services, particularly harm reduction and mental health services, would contribute to reducing mortality among the HCV-, HBV- and HIV-affected populations.”