20th January Mocroft et al., Hepatitis B virus infection and nonliver malignancies

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

Mocroft and Miró et al. aimed to determine whether people living with HIV (PLWH) and hepatitis B virus (HBV) in the EuroSIDA study are at increased risk for nonliver cancer compared to PLWH without HBV.

All participants from the EuroSIDA study with known HBV status were included. HBV coinfection was defined as positive HBsAg, and the main outcome was the occurrence of any nonliver malignancy, including anal cancer, lung cancer, non-Hodgkin’s lymphoma and other cancers. Multivariable Poisson regression was used to compare incidence rates between individuals with and without HBV coinfection. The roles of HBV treatment and detectable HBV DNA were explored in additional models.

The study included 17’485 individuals, contributing 151’766 person-years of follow-up (PYFU). The median age was 41 years (IQR 35-49), median CD4 count 440 cells/μL (IQR 284-634), and 4’601 (26.3%) were women. HBV coinfection was present in 1’269 (7.2%) cohort participants. A total of 1’360 nonliver cancers occurred in 1’298 individuals (incidence rate [IR] 8.55 per 1’000 PYFU, 95% CI 8.09-9.92). The most common cancers were anal cancer (188 events), lung cancer (147 events) and non-Hodgkin’s lymphoma (131 events). In a multivariable analysis adjusted for age, CD4 cell count, HIV viral load, liver fibrosis and smoking status, individuals with HBV coinfection were at increased risk for the development of any nonliver malignancy compared to those without HBV (incidence rate ratio [IRR] 1.23, 1.00-1.51). The increased risk for HBV infected vs. HBV uninfected PLWH was most pronounced in individuals who did not receive tenofovir, emtricitabine or lamivudine during follow-up (IRR 1.45, 1.04-2.01), and in persons with detectable HBV DNA (IRR 1.37, 1.00-1.89 compared to HBV negative individuals).

In summary, the present study indicates that people living with HIV and HBV may be at increased risk for nonliver cancer. The association was strongest for individuals without HBV-active treatment and detectable HBV DNA, suggesting a role of HBV replication as a possible risk factor for the development of nonliver malignancies.


12th January Balakrishna et al. Bacterial pneumonia in the SHCS

Decreasing incidence and determinants of bacterial pneumonia in people with HIV: The Swiss HIV Cohort Study.    Journal of Infectious Diseases

Balakrishna et al. aimed to estimate the incidence rate of bacterial pneumonia in the Swiss HIV Cohort Study (SHCS) and to assess the risk factors associated with incidence of bacterial pneumonia.

The authors included 12’927 people with HIV (PWH) with follow-ups between 2008 and 2018. These patients had 985 bacterial pneumonia events during a follow-up of 100’779 person-years. Bacterial pneumonia incidence significantly decreased from 13.2 cases/1000 person-years in 2008 to 6.8 cases/1000 person-years in 2018. Older age, lower education level, intravenous drug use, smoking, lower CD4-cell count, higher HIV load, and prior pneumonia were significantly associated with higher bacterial pneumonia incidence. Notably, CD4 cell counts 350–499 cells/μL were significantly associated with an increased risk compared to CD4 ≥ 500 cells/μL (adjusted hazard ratio, 1.39; 95% confidence interval, 1.01–1.89).

In conclusion, decreasing incidence over the last decade can be explained by increased CD4-cell counts and viral suppression and decreased smoking frequency. Hence, improvements in the cascade of care of HIV and decrease in smoking may have mediated a substantial decrease in bacterial pneumonia incidence.


6th January Kowalska et al., Prevalence and outcomes of pregnancies in women with HIV

Prevalence and outcomes of pregnancies in women with HIV over a 20-year period.    AIDS

Kowalska et al. evaluated time trends and outcomes of pregnancies among European women with HIV between 1996 and 2015 in the EuroSIDA cohort.

Audits were performed annually to collect information on pregnancies in female cohort participants aged between 16 and 50 years. Outcomes were categorized as birth of a HIV negative child, HIV positive child or child with unknown HIV status, stillbirth, spontaneous abortion, medical abortion, still pregnant or unknown. Pregnancy trends were analysed in three distinct periods: 1996-2002, 2003-2009 and 2010-2015, and logistic regression with generalized estimating equations was performed to assess factors associated with pregnancy.

The study included 5’535 women of reproductive age, median age of 33 years (IQR 29-39 years), most were of white ethnicity, and 62% acquired HIV heterosexually. Of those women, 4’217 (76.2%) had pregnancy information available. Between 1996 and 2015, 912 women reported a total of 1’315 pregnancies. The proportion of women who reported at least one pregnancy was 15.3% between 1996 and 2002, 17.3% between 2003 and 2009, and 12.6% between 2010 and 2015. In multivariable analyses, younger women, women with previous pregnancies and participants from Western/Central and Northern Europe were most likely to report a pregnancy, whereas women from South, Central East and Eastern Europe and individuals with previous AIDS-defining illnesses were less likely to report a pregnancy. Out of 690 live births (69.1%), 23 children were HIV-positive (3.3%), 342 were HIV-negative (49.6%), and the HIV status was unknown in 325 (47.1%). Spontaneous abortions occurred in 103 pregnancies, and 199 women had medical abortions.

In summary, the present study shows that around 22% of women in the EuroSIDA cohort reported one or more pregnancies. The highest proportion of pregnancies occurred between 2003 and 2009, and declined in recent years - reflecting trends in the general population. Women reported a high rate of medical abortions, highlighting the importance of integrating family planning and ensuring access to sexual health counselling for women with HIV.