The association between hepatitis B virus infection and nonliver malignancies in persons living with HIV: results from the EuroSIDA study

Abstract

Objectives The aim of this study was to assess the impact of hepatitis B virus (HBV) infection on non‐liver malignancies in people living with HIV (PLWH). Methods All persons aged ≥ 18 years with known hepatitis B virus (HBV) surface antigen (HBsAg) status after the latest of 1 January 2001 and enrolment in the EuroSIDA cohort (baseline) were included in the study; persons were categorized as HBV positive or negative using the latest HBsAg test and followed to their first diagnosis of nonliver malignancy or their last visit. Results Of 17 485 PLWH included in the study, 1269 (7.2%) were HBV positive at baseline. During 151 766 person‐years of follow‐up (PYFU), there were 1298 nonliver malignancies, 1199 in those currently HBV negative [incidence rate (IR) 8.42/1000 PYFU; 95% confidence interval (CI) 7.94–8.90/1000 PYFU] and 99 in those HBV positive (IR 10.54/1000 PYFU; 95% CI 8.47–12.62/1000 PYFU). After adjustment for baseline confounders, there was a significantly increased incidence of nonliver malignancies in HBV‐positive versus HBV‐negative individuals [adjusted incidence rate ratio (aIRR) 1.23; 95% CI 1.00–1.51]. Compared to HBV‐negative individuals, HBsAg‐positive/HBV‐DNA‐positive individuals had significantly increased incidences of nonliver malignancies (aIRR 1.37; 95% CI 1.00–1.89) and NHL (aIRR 2.57; 95% CI 1.16–5.68). There was no significant association between HBV and lung or anal cancer. Conclusions We found increased rates of nonliver malignancies in HBsAg‐positive participants, the increases being most pronounced in those who were HBV DNA positive and for NHL. If confirmed, these results may have implications for increased cancer screening in HIV‐positive subjects with chronic HBV infection.

The role of HIV/hepatitis B virus/hepatitis C virus RNA+ triple infection in end-stage liver disease and all-cause mortality in Europe

“…The type of ESLD did not differ across the three strata, but there were some differences in the cause of death, with AIDS and extrahepatic malignancies being common causes of death, as reported previously [35,36]. Deaths from liver-related causes were less common in those with HIV/HBV, where deaths from extrahepatic malignancies were more common, consistent with reports of an increased risk of extrahepatic malignancies in HIV/ HBV in EuroSIDA [32].…”

“…For ESLD, with fewer events, multivariate models were adjusted for fixed covariates at baseline, including the prespecified variables gender, HIV transmission category, region of Europe [28], nadir CD4 + , age, and liver fibrosis stage [31]. Smoking, diabetes, CD4 + cell count, HIV viral load, calendar year of follow-up and percentage of follow-up time treated with TDF or TAF with or without concomitant use of lamivudine or emtricitabine [XTC]) were included as time-updated variables (0, 0.1–50, >50% [32]). For all-cause mortality, additional variables including ethnicity, prior clinical diagnoses (AIDS, cardiovascular disease, extrahepatic non-AIDS-defining malignancies [33]), and BMI were included in models, fixed at baseline.…”