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HBV/HIV coinfection leads to poorer outcomes in hospitalized patients

Recent findings published in the Journal of Viral Hepatitis showed that HBV/HIV coinfection led to poorer outcomes in hospitalized patients compared with those infected with either HBV or HIV alone.

“Published literature has established that HBV/HIV coinfection progresses to cirrhosis faster than HBV alone and is associated with higher liver-related mortality than HIV alone,” Ruma Rajbhandari, MD, PhD, gastroenterology fellow at Massachusetts General Hospital, and colleagues wrote. “In a large nationwide study of hospitalized patients, we demonstrate that HBV/HIV coinfection is associated with higher in-hospital mortality, length of stay and hospitalization costs than those with HBV alone.”

Prevalence of HBV coinfection among those already infected with HIV ranges from 6% in the United States and Europe to 10% in Africa, South America and Asia, the researchers wrote. Although studies have already assessed overall HBV/HIV coinfection outcomes, no studies have examined these outcomes among hospitalized patients, who could be more vulnerable to poorer outcomes.

Thus, Rajbhandari and colleagues compared outcomes of HBV/HIV coinfection in hospitalized patients with those who had either HBV or HIV alone, using the 2011 US Nationwide Inpatient Sample. The researchers compared liver-related admissions between these three groups and performed multivariable logistic regression to identify independent predictors of in-hospital mortality, length of stay and total charges. Overall, there were 72,584 discharges of HBV alone, 133,880 discharges with HIV and 8,156 discharges with HBV/HIV coinfection.

They found that HBV/HIV coinfection was associated with higher mortality compared with HBV alone (OR = 1.67; 95% CI, 1.3-2.15), but not HIV (OR = 1.22; 95% CI, 0.96-1.54). However, HBV coinfection along with cirrhosis or complications of portal hypertension was associated with a three times greater mortality (OR = 3; 95% CI, 1.8-5.02). In addition, coinfection was associated with greater length of stay and total hospitalization charges compared with HBV alone (1.53 days, P < .001; $17,595, P < .001) and HIV (0.62 days, P = .034; $8840, P = .005). This held true when coinfection, as well as HIV or HBV alone, were compared with all-cause hospitalizations.

“This suggests that the overall healthcare utilization and costs associated with either HBV or HIV infection are higher than the national average for all hospitalizations,” the researchers wrote. “Policy-makers should be aware of the financial implications of coinfection as they allocate scarce healthcare resources and establish capitated costs for accountable care organizations.” – by Will Offit

Disclosures: Rajbhandari reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.