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

Area of Science:

• Infectious Diseases
• Hepatology
• Public Health

Background:

• Chronic hepatitis B virus (HBV) infection poses risks for cirrhosis and liver cancer.
• Human immunodeficiency virus (HIV) co-infection exacerbates HBV progression and mortality.
• Data on HIV/HBV co-infection impact among treated individuals in Sub-Saharan Africa is limited.

Purpose of the Study:

• To evaluate all-cause mortality in individuals with chronic HBV receiving treatment.
• To assess the specific impact of HIV/HBV co-infection on mortality in this population.

Main Methods:

• Retrospective cohort study using Rwanda's District Health Information System 2 (2016-2023).
• Included individuals aged ≥2 years treated for HBV.
• Multilevel Cox proportional hazards regression analyzed mortality risk associated with HIV/HBV co-infection.

Main Results:

• 4843 individuals treated for HBV (3905 HBV mono-infection, 838 HIV/HBV co-infection).
• Overall crude mortality rate: 1.6 per 1000 person-years (PY).
• HIV/HBV co-infection showed a higher mortality rate (3.3 vs. 1.1 per 1000 PY) and was associated with increased all-cause mortality (aHR 4.07).

Conclusions:

• Mortality is low among HBV-treated individuals in Rwanda.
• HIV co-infection significantly elevates mortality risk in HBV-treated patients.
• Emphasizes the need for closer follow-up of HIV/HBV co-infected individuals and further research into HIV viral load suppression.