Helmholtz Centre for Infection Research (HZI)-PhD Program "Epidemiology", Brunswick, Germany.
Department of Epidemiology, Helmholtz-Zentrum Für Infektionsforschung GmbH (4214), Inhoffenstr. 7, 38124, Brunswick, Germany.
BMC Infect Dis. 2022 May 27;22(1):500. doi: 10.1186/s12879-022-07477-1.
There remain gaps in quantifying mortality risk among individuals co-infected with chronic hepatitis B (HBV) and human immunodeficiency virus (HIV) in sub-Saharan African contexts. Among a cohort of HIV-positive individuals in Rwanda, we estimate the difference in time-to mortality between HBV-positive (HIV/HBV co-infected) and HBV-negative (HIV mono-infected) individuals.
Using a dataset of HIV-infected adults screened for hepatitis B surface antigen (HBsAg) from January to June 2016 in Rwanda, we performed time-to-event analysis from the date of HBsAg results until death or end of study (31 December 2019). We used the Kaplan-Meier method to estimate probability of survival over time and Cox proportional hazard models to adjust for other factors associated with mortality.
Of 21,105 available entries, 18,459 (87.5%) met the inclusion criteria. Mean age was 42.3 years (SD = 11.4) and 394 (2.1%) died during follow-up (mortality rate = 45.7 per 100,000 person-months, 95% confidence interval (CI) 41.4-50.4) Mortality rate ratio for co-infection was 1.7, 95% CI 1.1-2.6, however, Cox regression analysis did not show any association with mortality between compared groups. The adjusted analysis of covariates stratified by co-infection status showed that males, residing outside of the capital Kigali, drinking alcohol, WHO-HIV-clinical stage 3 and 4 were associated with increased mortality in this HIV cohort.
HBV infection does not significantly influence mortality among HIV-infected individuals in Rwanda. The current cohort is likely to have survived a period of high-risk exposure to HBV and HIV mortality and limited health care until their diagnosis.
在撒哈拉以南非洲地区，对于慢性乙型肝炎（HBV）和人类免疫缺陷病毒（HIV）合并感染个体的死亡率风险量化仍存在差距。在卢旺达的一个 HIV 阳性个体队列中，我们估计 HBV 阳性（HIV/HBV 合并感染）和 HBV 阴性（HIV 单感染）个体之间的死亡率差异。
利用 2016 年 1 月至 6 月期间在卢旺达筛查乙型肝炎表面抗原（HBsAg）的 HIV 感染成年人的数据集，我们对 HBsAg 结果日期至死亡或研究结束日期（2019 年 12 月 31 日）的时间进行了事件时间分析。我们使用 Kaplan-Meier 方法估计随时间的生存概率，并使用 Cox 比例风险模型调整与死亡率相关的其他因素。
在 21,105 个可用条目，18,459 个（87.5%）符合纳入标准。平均年龄为 42.3 岁（标准差=11.4），随访期间有 394 人（2.1%）死亡（死亡率=45.7/100,000 人月，95%置信区间[CI] 41.4-50.4）。合并感染的死亡率比值为 1.7，95%CI 1.1-2.6，但 Cox 回归分析未显示比较组之间与死亡率相关的任何关联。按合并感染状态分层的协变量调整分析表明，男性、居住在首都基加利以外、饮酒、世界卫生组织（WHO）-HIV 临床分期 3 和 4 与该 HIV 队列的死亡率增加相关。
HBV 感染不会显著影响卢旺达 HIV 感染者的死亡率。目前的队列可能已经度过了高危暴露于 HBV 和 HIV 死亡率和有限的医疗保健直到他们的诊断的时期。
