Johns Hopkins University, Baltimore, MD, USA.
Background and Aims: It is not known whether chronic hepatitis B (CH-B) or chronic hepatitis C (CH-C) carries a greater risk of liver-related mortality. This study compared rates of liver-related mortality between these two groups in the Multicenter AIDS Cohort Study (MACS.
Methods: 680 men with CH-B (n=337) or CH-C (n=343) at study entry into the MACS were prospectively followed to death, last follow-up visit, or March 30, 2010, whichever came first. 472 (69.4%) of these men were HIV-1 infected. Causes of death were obtained from death registry matching and death certificates. Liver-related and all-cause mortality rates (MR) were compared between groups using Poisson regression and adjusted for potential confounders and competing risks.
Results: In 6728 person-years (PYs) of follow-up, there were 293 deaths from all causes (43.5/1000 PYs) of which 51 were liver-related (7.6/1000 PYs). The all-cause MR was similar between those with CH-B and CH-C; however, the liver-related MR was significantly higher in those with CH-B (9.6/1000 PYs, 95% CI 6.9-13.2) than with CH-C (5.0/1000 PYs, 95% CI 3.0-8.4). In the HIV-infected subgroup, which had 46 (90.2%) of the liver-related deaths, the liver-related MR remained higher from CH-B after adjusting for potential confounders (IRR 2.2, P=0.03) and competing risks (SHR 2.4, P=0.02). Furthermore, amongst HIV-infected subjects, CD4 cell counts <200 cells/mm(3) were associated with a 16.2-fold (95% CI 6.1-42.8) increased risk of liver-related death compared to CD4 cell counts >350cell/mm3.
Conclusion: CH-B carries a higher risk of death from liver disease than does CH-C especially in HIV-infected men with greater immunosuppression.