Impact of Hepatitis B Exposure and/or HIV Co‐Infection on Clinical Outcomes in Chronic Hepatitis C Patients in Oman: An Ambidirectional Cohort Study

Data on the clinical impact of hepatitis B virus (HBV) exposure or human immunodeficiency virus (HIV) co-infection in patients with chronic hepatitis C virus (HCV) from the Middle East are limited. This ambidirectional cohort study at Sultan Qaboos University Hospital included 702 Omani adults with chronic HCV (2009-2017), followed through November 2024, to assess prevalence and outcomes of HBV exposure (HBsAg-negative/HBcAb-positive,reflecting possible occult infection) and HIV co-infection. Overall, 32.3% hadHBV exposure, 4.1% were HBsAg-positive, and 1.7% HIV-positive. Predictors of HBV exposure included older age (aOR: 0.34; p < 0.001), HIV co-infection (aOR: 6.23; p = 0.009), intravenous drug use (aOR: 1.58; p = 0.041), and cirrhosis (aOR: 1.46; p = 0.049). HBV-exposed patients demonstrated significantly higher rates of cirrhosis, hepatocellular carcinoma, and mortality, with lower 10- and 15-year survival (68.3% and 67.6%, respectively) compared to non-exposed patients (78.9% and 76.6%; p = 0.036). In conclusion, HBV exposure is highly prevalent among Omani chronic HCV patients and independently associates with advanced liver disease and reduced long-term survival. These findings underscore the critical need for routine HBV screening and enhanced hepatocellular carcinoma surveillance in this population to improve clinical outcomes.