All-Cause Mortality in Persons With HIV-HBV Co-Infection Treated for HBV in Rwanda: A Population-Based Cohort Study

Chronic hepatitis B virus (HBV) infection increases the risk of cirrhosis, hepatocellular carcinoma and non-liver complications. HIV co-infection accelerates disease progression and increases mortality risk compared to HBV mono-infection, but its impact among treated individuals is not well documented in Sub-Saharan Africa. We evaluated all-cause mortality among people with chronic HBV on treatment and assessed the effect of HIV/HBV co-infection. A retrospective cohort study using data from Rwanda's District Health Information System 2 included individuals aged ≥ 2 years treated for HBV between January 2016 and June 2022. Follow-up began 12 months after treatment initiation until death or 30 June 2023. Crude mortality rates were calculated, and multilevel Cox proportional hazards regression, accounting for hospital clustering, assessed the impact of HIV/HBV co-infection on all-cause mortality. Among 4843 people who received HBV treatment (3905 with HBV mono-infection and 838 with HIV/HBV co-infection), median follow-up was 3.8 (interquartile range 2.8) years. Thirty-four deaths occurred, yielding an overall crude mortality rate of 1.6 per 1000 person-years (PY). Mortality rate was higher among individuals with HIV/HBV co-infection compared to those with HBV mono-infection (3.3 vs. 1.1 per 1000 PY, respectively). HIV/HBV co-infection was associated with increased all-cause mortality (adjusted hazard ratio 4.07, 95% confidence interval: 1.71, 9.69). Mortality was low among HBV-treated individuals in Rwanda. However, HIV co-infection significantly increased mortality risk, highlighting the importance of closer follow-up of individuals with HIV/HBV co-infection and further studies on the role of HIV viral load suppression.