Impact of Socio-Economic, Behavioural and Clinical Factors on Liver Disease Progression in Individuals With HIV and Hepatitis B

Background and Aims: Little is known about the contribution of sociodemographic and behavioural factors to developing liver disease in individuals with an HIV and chronic hepatitis B virus (HBV) co-infection. We aimed to quantify the impact of these factors on incident liver disease in individuals with HIV/HBV receiving care in the Netherlands. Methods: We used data from the Dutch observational ATHENA cohort combined with Statistics Netherlands. We included all hepatitis B surface antigen-positive individuals with HIV in care from 2008–2022. Severe liver disease (i.e., significant fibrosis (≥F2), cirrhosis, hepatocellular carcinoma, liver transplantation) was defined by physician diagnosis or a transient elastography result > 7 kPa. Determinants of incident liver disease were assessed using Cox proportional hazard models. Results: In the 1319 individuals included (12,277 person-years (PY); 93.3% HIV-RNA < 200 copies/ml), the incidence rate of severe liver disease was 0.59 per 100 PY [95% confidence interval (CI) = 0.47–0.75]. After adjustment for age and time since HBV diagnosis, tobacco smoking, HCV coinfection and body mass index > 25 kg/m2 increased the risk of liver disease [adjusted hazards ratio (aHR) = 2.33, 95% CI = 1.38–3.94; aHR = 4.00, 95% CI = 2.18–7.33, aHR = 1.75, 95% CI = 1.05–2.92, respectively]. Conversely, men who have sex with men (vs. other transmission routes, aHR = 0.54, 95% CI = 0.32–0.90), and individuals living in an urbanised municipality (aHR = 0.50, 95% CI = 0.30–0.85) had a reduced risk of liver disease. Conclusions: Liver disease progression in people living with HIV/HBV appears to be linked to psychosocial/behavioural factors. More effective screening/management of coinfection and metabolic syndrome, as well as strategies for smoking cessation, should be included in clinical follow-up.