Background:  Hepatitis B (HBV) and C (HCV) are associated with liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) and progression is accelerated in the presence of HIV. We studied differences in liver disease progression between HCV and HBV co-infected HIV⁺ patients.

Methods:   All HIV-1-infected patients co-infected with HBV or HCV were selected from the Netherlands ATHENA national observational HIV cohort. Patients positive for HBsAg were defined as HBV-co-infected. Patients positive for HCV antibodies or HCV RNA were defined as HCV-co-infected. Liver disease was defined as having liver fibrosis, cirrhosis, or HCC. Time to liver disease was analyzed using a Cox proportional hazard model for those patients who initiated HAART, adjusted for age, gender, transmission risk group, and baseline CD4 cell count. Time was from HAART initiation until liver disease, death, or closure of the database (January 1, 2006). Data on liver disease was systematically collected from January 1, 2001 onward, left entry was used when HAART initiation was before January 1, 2001. Kaplan Meier method was used to compare the time from HAART initiation until death HBV-, HCV-coinfected, and both HBV- and HCV-co-infected patients.

Results:  Of the 12257 HIV-infected patients in the ATHENA cohort, 1129 (9%) patients were HCV-co-infected and 815 (7%) were HBV-co-infected; 31(0.3%) patients co-infected with both HBV and HCV were excluded from the analyses, because this number was too small. Among the co-infected patients, 31(2%) developed liver fibrosis, 71(4%) liver cirrhoses, and 5 (0.3%) HCC between 2001 and 2006. Of the HBV or HCV co-infected patients, 1651 (85%) initiated HAART and 246 (13%) died during follow-up.

The adjusted risk of liver disease was 1.93 (95% confidence interval (CI) 0.85 to 4.42) in HCV/HIV-co-infected patients compared to HBV/HIV-co-infected patients. By 5 years after HAART initiation, 7% (95%CI 5 to 10) of the HBV-, 14% (95%CI 11 to 16) of the HCV-, and 7% (95%CI 6 to 7) of the non-co-infected had died. HCV-co-infected patients died significantly faster than HBV-co-infected (p log rank test = 0.0001), time to death did not differ between HBV- and non-co-infected patients (p = 0.23).

Conclusions:  HCV-co-infected HAART-treated patients have a faster progression to hepatitis-related liver disease and to death than HBV/HIV-co-infected patients, suggesting that progression to liver-related disease may be faster in HCV-co-infected patients.