Increased All-cause Mortality in People With HIV and Comorbidities: Hepatitis B and C Virus Seropositivity and Hyperglycemia in Myanmar, 2005-2017

Nang Thu Thu Kyaw; Srinath Satyanarayana; Anthony D Harries; Ajay M V Kumar; Khine Wut Yee Kyaw; Khaing Hnin Phyo; Matthew J Hayat; Kenneth G Castro; Matthew J Magee

doi:10.1093/ofid/ofac672

Increased All-cause Mortality in People With HIV and Comorbidities: Hepatitis B and C Virus Seropositivity and Hyperglycemia in Myanmar, 2005-2017

Open Forum Infect Dis. 2022 Dec 13;10(1):ofac672. doi: 10.1093/ofid/ofac672. eCollection 2023 Jan.

Authors

Nang Thu Thu Kyaw^{1

2}, Srinath Satyanarayana^{3

4}, Anthony D Harries^{4

5}, Ajay M V Kumar^{4

6}, Khine Wut Yee Kyaw¹, Khaing Hnin Phyo¹, Matthew J Hayat⁷, Kenneth G Castro^{8

9}, Matthew J Magee⁸

Affiliations

¹ International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar.
² Myanmar and Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA.
³ International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India.
⁴ International Union Against Tuberculosis and Lung Disease, Paris, France.
⁵ Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁶ Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India.
⁷ Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA.
⁸ Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
⁹ Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA.

Abstract

Background: Hepatitis C virus (HCV) and hepatitis B virus (HBV) coinfection are associated with increased mortality in people with HIV (PWH), and hyperglycemia is a common comorbidity in PWH. In this study, we used routinely collected clinical data to assess the associations between HBV and HCV seropositivity with all-cause mortality and whether this relationship differs by hyperglycemia status.

Methods: Eligible participants included adult PWH (≥15 years) who initiated antiretroviral therapy between May 2005 and June 2016 in Myanmar. HBV and HCV serostatus and hyperglycemia were measured at enrollment to HIV care using HBV surface antigen, HCV antibody tests, and random blood glucose (≥140 mg/dL), respectively.

Results: Among 27 722 PWH, 2260 (8%) were HBV seropositive, 2265 (9%) were HCV seropositive, 178 (0.6%) were HBV-HCV seropositive, and 1425 (5%) had hyperglycemia. During the median follow-up (interquartile range) of 3.1 (1.5-5.1) years, 3655 (13%) PWH died, and the overall mortality rate was 3.8 (95% CI, 3.7-3.9) per 100-person-years (PY). The mortality rate (per 100 PY) among PWH who were HBV seropositive was 4.6, among PWH who were HCV seropositive it was 5.1, and among PWH who were HBV-HCV seropositive it was 7.1. When stratified by glycemic status, the mortality rate was higher among patients with hyperglycemia compared with those with euglycemia (5.4 vs 4.0 per 100 PY), and the difference in mortality rate between patients with hyperglycemia and euglycemia was highest among those with HCV seropositivity (9.8 vs 5.0 per 100 PY).

Conclusions: Increased mortality rates associated with HBV and HCV seropositivity in PWH differed by their glycemic status. PWH with HCV seropositivity and hyperglycemia had the highest mortality rates.

Keywords: HIV; hepatitis; hyperglycemia.