Background
Chronic hepatitis B virus (HBV) infection increases the risk of severe liver diseases such as cirrhosis, hepatocellular carcinoma, non-liver complications, and mortality. HIV co-infection contributes to the acceleration of liver disease progression, leading to greater mortality risk compared to HBV mono-infection. We evaluated the crude all-cause mortality rates among people with chronic HBV on treatment and assessed the impact of HBV/HIV co-infection on all-cause mortality.
Methods
A retrospective cohort study was conducted using data extracted from the Rwandan District Health Information System 2, which includes information on HBV screening, diagnosis, treatment, follow-up, and treatment outcomes. Rwandans diagnosed with HBV infection, age ≥ 2 years, who received treatment between January 2016 and June 2023 were considered in the analysis. Individuals were followed from the HBV testing date until death or end of the study period (June 30, 2023). We computed crude mortality rates and used multilevel Cox proportional hazard regression accounting for clustering by hospital adjusting for socio-demographic, and clinical characteristics to assess the impact of HBV/HIV co-infection on all-cause mortality.
Results
Overall, 4,849 people received HBV treatment during the study period (4,011 with HBV mono-infection and 838 with HBV/HIV co-infection) and were followed for a median of 3.8 (interquartile range 2.8) years. During follow-up, 58 deaths occurred, yielding an overall crude mortality rate of 2.76 per 1,000 person-years (PY). The mortality rate for people with HBV/HIV co-infection was higher than that for those with HBV mono-infection (4.30 vs 2.30 per 1,000 PY, respectively). In the multilevel model, HBV/HIV co-infection was associated with a higher hazard of all-cause mortality (adjusted hazard ratio 2.00, 95% confidence interval: 1.02, 3.92).
Conclusions
Among people in Rwanda who received HBV treatment, HBV/HIV co-infection was associated with mortality risk. Moreover, HIV co-infection was associated with increased mortality risk. These findings underscore the critical importance of closer follow-up of individuals with HBV/HIV co-infection. Further studies could explore the role of HIV viral load suppression on all-cause mortality among individuals with HBV/HIV co-infection.
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