Hepatitis B and C infection and liver disease trends among human immunodeficiency virus-infected individuals

Table 1 Characteristics of human immunodeficiency virus-infected individuals with chronic hepatitis B, hepatitis C, liver disease, and overall; Adult/adolescent spectrum of human immunodeficiency virus-related diseases project, 11 U.S. metropolitan areas; 1998-2004 n (%)

	Total	Chronic hepatitis B	Hepatitis C	Liver disease
Characteristic	= 29 490	= 23321	= 54632	= 8321
	(100%)	(8%)	(19%)	(3%)
Gender
Male	72	84	74	78
Female	28	16	26	22
Race/Ethnicity
White non-Hispanic	25	31	24	34
Black non-Hispanic	43	49	42	34
Hispanic	19	11	22	29
Asian/Pacific Islander non-Hispanic	1	1	< 1	1
Native American non-Hispanic	< 1	< 1	10	1
Other/unknown	11	8	< 1	2
Age (yr)
13-29	24	22	11	13
30-39	43	46	41	40
40-49	25	24	37	34
50+	8	7	11	13
HIV transmission mode:
MSM	39	48	17	30
IDU	18	18	49	39
IDU and MSM	7	12	15	12
Other (i.e. heterosexual or blood product exposure)	16	9	9	9
Unknown	20	13	10	10
Ever prescribed HAART
Yes	66	75	67	72
No	34	25	33	28
Nadir CD4 count in cells/µL
≥ 500	11	6	10	5
200-499	34	30	32	22
< 200	55	64	58	74
Highest viral load in copies per mL
Undetectable to 9999	28	23	25	19
10 000-99 999	33	33	32	32
100 000-999 999	33	38	35	42
1 000 000 and higher	7	7	8	7
Vital status
Alive	85	80	80	43
Died	15	20	20	57
AIDS diagnosis
Never diagnosed with AIDS	37	26	32	19
AIDS	63	74	68	81
Substance use
Alcohol use/problem drinking	23	31	40	49
Non-IDU	29	39	44	37
Ongoing IDU	8	10	25	17

¹All comparisons of clinical and demographic characteristics presented in this table between individuals with and without chronic Hepatitis B virus and with and without liver disease are highly statistically significant (P values ≤ 0.001);

²All except two comparisons between individuals with and without chronic hepatitis C virus (HCV) are highly statistically significant (P values ≤ 0.001). These exceptions are gender and HCV (P = 0.004) and highly active antiretroviral (HAART) and HCV (P = 0.05). MSM: Male-male sex; IDU: Injection drug use.

Table 2 Chronic and acute hepatitis B, hepatitis C, and liver disease prevalence versus incidence (and rates of disease occurrence) among human immunodeficiency virus-infected individuals: Adult/adolescent spectrum of human immunodeficiency virus-related diseases project, 11 U.S. metropolitan areas; 1998-2004 (n)

Diagnoses	Total	Incident	Present at baseline
	(% of 29 490)	[rate per 100 person-years (py)]	(% of 29 490)
All liver disease	832 (3)	621 (0.9/100 py)	212 (1)
Chronic hepatitis B	2332 (8)	1212 (1.8/100 py)	1120 (4)
Hepatitis C	5463 (19)	3129 (4.7/100 py)	2334 (8)
Acute hepatitis B	862 (3)	575 (0.8/100 py)	287 (1)

Table 3 Types of liver disease diagnosed among human immunodeficiency virus-infected individuals. Adult/adolescent spectrum of human immunodeficiency virus-related diseases project, 11 U.S. metropolitan areas; 1998-2004 n (%)

Liver diseases diagnosed	Not exclusive categories
All liver disease	832 (100)
All cirrhosis	389 (47)
Non-alcoholic cirrhosis	262 (31)
Alcoholic cirrhosis	165 (20)
Both	38 (5)
Other alcoholic liver disease excluding cirrhosis	39 (5)
Liver cancer	25 (3)
Liver failure (not otherwise specified)	22 (3)
Other liver diseases	244 (29)

Table 4 Overall death rates and deaths potentially due to liver disease among individuals with chronic hepatitis B, hepatitis C, and liver disease diagnoses among human immunodeficiency virus-infected individuals followed by the Adult/adolescent spectrum of human immunodeficiency virus-related diseases project, 11 U.S. metropolitan areas; 1998-2004

Diagnoses	Number of deaths	Overall death rate [Per 1000 person-years (py)]	Potential liver disease death rate [(Per 1000 person-years py)]1
Entire cohort	4461	64.2	2.9
Liver disease	475	73.0	31.0
HCV	1073	74.4	7.0
Chronic hepatitis B	455	68.9	6.4
No HCV, no chronic HBV	3099	61.4	1.5

¹A potential liver disease death was a death where liver disease was included as a contributing factor on a death certificate or a death occurring within approximately six months of a new or ongoing diagnosis of liver disease. HCV: Hepatitis C virus; HBV: Hepatitis B virus.

Table 5 Correlates of liver disease, chronic hepatitis B virus, and hepatitis C virus by multivariate (proportional hazards) analyses. Adult/adolescent spectrum of human immunodeficiency virus-related diseases project, 11 U.S. metropolitan areas; 1998-2004

	Proportional hazards ratio1-an estimate of relative risk (95% CI)
Characteristic	Liver disease	Chronic HBV	HCV
Male gender	1.2 (1.0-1.5)	1.7 (1.4-2.0)	1.3 (1.1-1.4)
White non-hispanic	1.9 (1.6-2.3)	1.0 (0.9-1.1)	1.3 (1.1-1.4)
Hispanic	2.2 (1.8-2.7)	0.7 (0.6-0.8)	1.4 (1.3-1.4)
Asian/pacific islander non-hispanic	2.3 (1.1-5.0)	1.0 (0.5-1.8)	1.0 (0.6-1.7)
Native American non-Hispanic	3.1 (1.5-6.3)	0.3 (0.1-1.3)	1.4 (0.9-2.1)
Each increase in decade of age relative to those 13-29 yr	1.4 (1.3-1.5)	1.0 (1.9-1.1)	1.3 (1.2-1.3)
MSM	0.9 (0.7-1.1)	1.4 (1.2-1.7)	0.7 (0.7-0.8)
IDU	2.2 (1.8-2.6)	1.2 (1.1-1.4)	4.7 (4.4-5.1)
Hemophiliac	2.6 (1.0-6.5)	0.9 (0.3-2.8)	7.0 (4.8-10.2)
HAART	1.0 (0.8-1.2)	0.1 (0.1-0.2)	0.4 (0.4-0.4)
CD4 < 200 cells/microliter	1.8 (1.2-2.6)	3.9 (2.9-5.2)	1.6 (1.4-1.9)
CD4 200-499 cells/microliter	1.0 (0.7-1.5)	2.0 (1.5-2.7)	1.3 (1.1-1.5)
Alcohol use/problem drinking	1.4 (1.1-1.6)	0.7 (0.6-0.8)	1.1 (1.0-1.2)
Chronic HBV	1.4 (1.1-1.7)	N/A	1.3 (1.1-1.4)
HCV	1.6 (1.3-1.9)	1.6 (1.4-1.8)	N/A

¹Adjusted for each factor in the model plus intensity of health services utilization (number outpatient visits in a grouped linear variable) and study entry year. HAART: Highly active antiretroviral; CD4: CD4+ lymphocyte; N/A indicates not applicable; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MSM: Male-male sex; IDU: Injection drug use.