HIV Makes Hepatitis B Significantly More Lethal

Researchers at Johns Hopkins found that men infected with a combination of hepatitis B and HIV are 17 times more likely to die than those with hepatitis B alone. "These results underscore the importance of prevention, treatment and comprehensive management of hepatitis B in people infected with HIV," said Chloe Thio, M.D., lead author of the study and assistant professor of medicine in the division of infectious diseases at Johns Hopkins.

The low rate of liver disease-related deaths in men with hepatitis B alone is consistent with the 20-30 years it typically takes for complications from hepatitis B to develop, Thio explained. The full report, "HIV-1, Hepatitis B Virus, and Risk of Liver-Related Mortality in the Multicenter Cohort Study (MACS)," was published in the Lancet (2002;360;9349). However, since HIV and hepatitis B are transmitted the same way, coinfection is common. Up to ten percent of the HIV-infected also have hepatitis B. "Our results suggest that HIV increases the severity of hepatitis B infections, and that physicians may see an increase of hepatitis B-related liver disease in the 1 million people living with HIV in the United States," said Thio.

Thio and colleagues analyzed clinical data and blood and tissue samples from 5,293 men in the Multicenter AIDS Cohort Study from 1994 to 2000. The researchers compared death rates from liver disease for four patient groups: HIV-infected men, hepatitis-B infected men, men with both viruses, and men with no viruses.

They found that 6 percent of the men (326) had hepatitis B. Of those, 213 (65 percent) also had HIV. Of the 4,987 men without hepatitis B, 2,346 (47 percent) had HIV. Liver disease-related death was highest in men with advanced HIV (measured by CD4 cell count) and was twice as high after 1996, when highly effective HIV therapies were introduced.

"Determining possible adverse effects of long-term use of HIV therapies and assessing the possible interaction with hepatitis infections are central questions that our ongoing studies will address," said Alvaro Mu, Ph.D., professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

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