Reuters Health Information (2012-05-16): Gay men have higher liver-related mortality from HBV than HCV
Gay men have higher liver-related mortality from HBV than HCV
Last Updated: 2012-05-16 16:20:19 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In a population of men who have sex with men (MSM) -- with a high prevalence of HIV infection -- chronic hepatitis B virus (HBV) led to twice as many liver-related deaths as chronic hepatitis C virus (HCV), researchers report.
"Our findings further highlight the need to expand screening for, and vaccination against, hepatitis B. Individuals found to be infected with hepatitis B need to get evaluated for treatment," lead investigator Dr. Oluwaseun Falade-Nwulia told Reuters Health by email.
In an April 20th online paper in Clinical Infectious Diseases, Dr. Falade-Nwulia of Johns Hopkins University School of Medicine, Baltimore, Maryland and colleagues reported on 680 men with HBV and 343 with HBC taking part in the Multicenter AIDS Cohort Study, including 472 (69.4%) with HIV-1.
Over 6,728 person-years of follow-up, there were 293 deaths from all causes, including 51 from liver disease. The mortality rate per 1,000 person-years was similar between HBV and HBC groups (41.2 vs 46.4) - but liver-related mortality was significantly higher in HBV patients (9.6 vs 5.0).
Forty-six of 51 liver-related deaths were in men with HIV. This gave a corresponding mortality rate per 1,000 person-years of 10.7 in HIV patients and 2.1 in those without HIV.
In HIV-infected men, the liver-related mortality rate has fallen since 2002 in both in those with HBV and those with HCV.
HIV men with CD4 cell counts below 200 cells/mm3 had a 16.2 fold increased risk of liver-related death compared to those with counts beyond 350 cells/mm3.
The authors call for more studies "to determine whether the results are applicable to women, HIV-uninfected individuals or to men who are infected with HBV or HCV through other routes."
Although not directly comparable, a large prospective study in a general Taiwanese population also showed the negative influence of HBV. Participants with inactive HBV were twice as likely to have a liver-related death as controls negative for HBV surface antigen and antibody against HCV. (See Reuters Health report of February 15, 2010.)
The authors of the current study say it "emphasizes the need for a more aggressive approach to the prevention, diagnosis, and treatment of chronic hepatitis B including increasing vaccination rates among all hepatitis B susceptible individuals."
Although fatalities are greater in the immunocompromised, Dr. Falade-Nwulia pointed out that "everyone, regardless of HIV status should be evaluated for treatment of hepatitis B."
Dr. Falade-Nwulia added, "We need to more effectively use the tools we already have against hepatitis B and continue to work towards finding a cure."
Dr. Lionel Piroth of CHU Dijon, France, who did not take part in the study, told Reuters Health by email "I agree with the comments of the authors." He said the new results complement findings he and his colleagues reported several years ago (see Reuters Health report of September 10, 2010), namely, that HIV does not appear to affect the success of HBV treatment.
The US findings, he added, "strengthen the 'old' recommendations to screen and vaccinate (if no HBV serological markers detected) HIV-infected patients against HBV. Furthermore, and even though not statistically significant, the temporal trend observed... highlights the need and the interest of efficient anti-HBV therapy on the clinical evolution of the patients."
Clin Infect Dis 2012.