Background: Hepatitis B (HBV) and Human Immunodeficiency Virus (HIV) share common risk factors for exposure.\nCo-infected patients have an increased liver-related mortality risk and may have accelerated HIV progression. The\nepidemiology and demographic characteristics of HIV-HBV co-infection in Canada remain poorly defined. We\ncompared the demographic and clinical characteristics and factors associated with advanced hepatic fibrosis\nbetween HIV and HIV-HBV co-infected patients.\nMethods: A retrospective cohort analysis was conducted using data from the Canadian Observational Cohort\n(CANOC) Collaboration, including eight sites from British Columbia, Quebec, and Ontario. Eligible participants were\nHIV-infected patients who initiated combination ARV between January 1, 2000 and December 14, 2014.\nDemographic and clinical characteristics were compared between HIV-HBV co-infected and HIV-infected groups\nusing chi-square or Fisher exact tests for categorical variables, and Wilcoxonâ??s Rank Sum test for continuous\nvariables. Liver fibrosis was estimated by the AST to Platelet Ratio Index (APRI).\nResults: HBV status and APRI values were available for 2419 cohort participants. 199 (8%) were HBV co-infected.\nCompared to HIV-infected participants, HIV-HBV co-infected participants were more likely to use injection drugs\n(28% vs. 21%, p = 0.03) and be HCV-positive (31%, vs. 23%, p = 0.02). HIV-HBV co-infected participants had lower\nbaseline CD4 T cell counts (188 cells/mm3, IQR: 120â??360) compared to 235 cells/mm3 in HIV-infected participants\n(IQR: 85â??294) (p = 0.0002) and higher baseline median APRI scores (0.50 vs. 0.37, p < 0.0001). This difference in APRI\nwas no longer clinically significant at follow-up (0.32 vs. 0.30, p = 0.03). HIV-HBV co-infected participants had a\nhigher mortality rate compared to HIV-infected participants (11% vs. 7%, p = 0.02).\nConclusion: The prevalence, demographic and clinical characteristics of the HIV-HBV co-infected population in\nCanada is described. HIV-HBV co-infected patients have higher mortality, more advanced CD4 T cell depletion, and\nliver fibrosis that improves in conjunction with ARV therapy. The high prevalence of unknown HBV status\ndemonstrates a need for increased screening among HIV-infected patients in Canada.
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