Treatment outcomes of HIV patients with hepatitis B and C virus co-infections in Southwest China:an observational cohort study

Background:Antiretroviral therapy(ART)has reduced mortality among people living with HIV(PLWH)in China,but co-infections of hepatitis B virus(HBV)and hepatitis C virus(HCV)may individually or jointly reduce the effect of ART.This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART.Methods:A retrospective cohort study analysis of 58,239 people living with HIV(PLWH)who initiated antiretroviral therapy(ART)during 2010-2018 was conducted in Guangxi Province,China.Data were from the observational database of the National Free Antiretroviral Treatment Program.Cox proportional hazard models were fitted to evaluate the effects of baseline infection of HBV or HCV or both on death and treatment attrition among PLWH.Results:Our study showed high prevalence of HBV(11.5%),HCV(6.6%)and HBV-HCV(1.5%)co-infections.The overall mortality rate and treatment attrition rate was 2.95[95%confidence interval(CI):2.88-3.02]and 5.92(95%CI:5.82-6.01)per 100 person-years,respectively.Compared with HIV-only patients,HBV-co-infected patients had 42%higher mortality[adjusted hazard ratio(a HR)=1.42;95%CI 1.32-1.54],HCV-co-infected patients had 65%higher mortality(a HR=1.65;95%CI:1.47-1.86),and patients with both HCV and HBV co-infections had 123%higher mortality(a HR=2.23;95%CI:1.87-2.66).Conclusions:HBV and HCV coinfection may have an additive effect on increasing the risk of all-cause death among PLWH who are on ART.It is suggested that there is need for primary prevention and access to effective hepatitis treatment for PLWH.

Treatment for HIV prevention study in southwestern areas of China

Background:China has ambitious to achieve significant reductions in HIV transmission and HIV-related mortality by adopting the World Health Organization's“Treat All”approach.Such a prevention strategy is needed future study on regional scale.Methods:An observational cohort study of HIV epidemiology and treatment databases was used to study the effectiveness of antiretroviral therapy on the transmission of HIV in serodiscordant couples in Guangxi of China.Results:A total of 7713 couples were entered into the cohort study analysis which included 1885 couples in the treatment-naive cohort and 5828 couples in the treated cohort.During the follow-up of 18985.29 person-years from 2003 to 2014,the average incidence of HIV was 2.4 per 100 person-years(95%CI 2.1e2.6).HIV seroincidence rate was significantly higher among the treatment naive group(4.2 per 100 person-years,3.7e4.8)compared with the on treatment group(1.6 per 100 person-years,1.3e1.8).An overall 45%reduction in risk of HIV transmission among serodiscordant couple was associated with ART treatment(adjusted Hazard Ratio[HR]0.55,95%Confidence Interval[CI]0.44e0.69).Treatment prevention had significantly effectiveness for most baseline characteristics of index partners,such as for male,female,age above 25 years,education below high school,farmer,infected by heterosexual intercourse.Conclusion:Treatment-as-prevention can be implemented in the real-world on a national or regional scale,but ART adherence and comprehensive harm reduction while implementing this strategy require further study.