Multidimensional Social Vulnerability and Hepatic and Extrahepatic Outcomes in Adults With HIV/HBV Coinfection in the United States
- 1Case Western Reserve University
Abstract
BackgroundHIV/HBV coinfection is associated with substantial liver-related morbidity and mortality, yet the impact of social vulnerability (SV) on clinical outcomes has not been systematically assessed. We evaluated associations of multidimensional SV with mortality, hepatic, virologic, and extrahepatic organ outcomes among adults with HIV/HBV.
MethodsWe conducted a retrospective cohort study using TriNetX data from 110 U.S. healthcare organizations (2010-2026). We propensity score matched adults with HIV/HBV with and without documented SV 1:1 (2,024 per group). SV was defined using a four-domain framework encompassing material, healthcare access and engagement, interpersonal, and psychosocial vulnerability.
ResultsOver 15,900 person-years, SV was associated with higher mortality (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.72-2.47), liver composite events (HR, 1.37; 95% CI, 1.07-1.76), hepatic decompensation (HR, 1.94; 95% CI, 1.39-2.70), hepatic failure (HR, 2.39; 95% CI, 1.53-3.73), HBV viremia (HR, 1.69; 95% CI, 1.32-2.16), and HIV viremia (HR, 2.05; 95% CI, 1.71-2.46). SV was also associated with major adverse cardiovascular events (HR, 1.47), chronic kidney disease (HR, 1.49), and diabetes (HR, 1.25). Multidomain SV generally showed stronger associations than single-domain SV for most hepatic and virologic outcomes, with HR ranges of 1.76-2.62 versus 1.35-1.76 for single-domain SV. Healthcare access and engagement vulnerability was most consistently associated with mortality and hepatic outcomes.
ConclusionsSV was associated with mortality, hepatic disease, impaired HIV/HBV control, extrahepatic organ morbidity, and acute care utilization in adults with HIV/HBV. SV assessment may improve risk stratification and identify actionable intervention targets during HIV/HBV care.
Graphical abstract
O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=110 SRC="FIGDIR/small/26361853v1_ufig1.gif" ALT="Figure 1"> View larger version (35K): [email protected]@15e4ad9org.highwire.dtl.DTLVardef@18409fborg.highwire.dtl.DTLVardef@1ab6db4_HPS_FORMAT_FIGEXP M_FIG C_FIG
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BibTeX
@misc{yendewa2026multidimensional,
title = {{Multidimensional Social Vulnerability and Hepatic and Extrahepatic Outcomes in Adults With HIV/HBV Coinfection in the United States}},
author = {G. Yendewa and T. Chengsupanimit and A. Dehghani and A. Ahmed and A. Mohareb and C. Cohen and M. Freeman and H. N. Kim and I. Ofotokun and K. Dube},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.31.26361853},
url = {https://www.medrxiv.org/content/10.64898/2026.08.31.26361853v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Multidimensional Social Vulnerability and Hepatic and Extrahepatic Outcomes in Adults With HIV/HBV Coinfection in the United States
AU - G. Yendewa
AU - T. Chengsupanimit
AU - A. Dehghani
AU - A. Ahmed
AU - A. Mohareb
AU - C. Cohen
AU - M. Freeman
AU - H. N. Kim
AU - I. Ofotokun
AU - K. Dube
PY - 2026
DA - 2026/08/31
PB - medRxiv
DO - 10.64898/2026.08.31.26361853
UR - https://www.medrxiv.org/content/10.64898/2026.08.31.26361853v1
AB - BackgroundHIV/HBV coinfection is associated with substantial liver-related morbidity and mortality, yet the impact of social vulnerability (SV) on clinical outcomes has not been systematically assessed. We evaluated associations of multidimensional SV with mortality, hepatic, virologic, and extrahepatic organ outcomes among adults with HIV/HBV. MethodsWe conducted a retrospective cohort study using TriNetX data from 110 U.S. healthcare organizations (2010-2026). We propensity score matched adults with HIV/HBV with and without documented SV 1:1 (2,024 per group). SV was defined using a four-domain framework encompassing material, healthcare access and engagement, interpersonal, and psychosocial vulnerability. ResultsOver 15,900 person-years, SV was associated with higher mortality (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.72-2.47), liver composite events (HR, 1.37; 95% CI, 1.07-1.76), hepatic decompensation (HR, 1.94; 95% CI, 1.39-2.70), hepatic failure (HR, 2.39; 95% CI, 1.53-3.73), HBV viremia (HR, 1.69; 95% CI, 1.32-2.16), and HIV viremia (HR, 2.05; 95% CI, 1.71-2.46). SV was also associated with major adverse cardiovascular events (HR, 1.47), chronic kidney disease (HR, 1.49), and diabetes (HR, 1.25). Multidomain SV generally showed stronger associations than single-domain SV for most hepatic and virologic outcomes, with HR ranges of 1.76-2.62 versus 1.35-1.76 for single-domain SV. Healthcare access and engagement vulnerability was most consistently associated with mortality and hepatic outcomes. ConclusionsSV was associated with mortality, hepatic disease, impaired HIV/HBV control, extrahepatic organ morbidity, and acute care utilization in adults with HIV/HBV. SV assessment may improve risk stratification and identify actionable intervention targets during HIV/HBV care. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=110 SRC="FIGDIR/small/26361853v1_ufig1.gif" ALT="Figure 1"> View larger version (35K): [email protected]@15e4ad9org.highwire.dtl.DTLVardef@18409fborg.highwire.dtl.DTLVardef@1ab6db4_HPS_FORMAT_FIGEXP M_FIG C_FIG
ER -