AIDS diagnosis triples risk of death in Spanish with HIV and HCV
An AIDS diagnosis and advanced liver fibrosis independently raise the risk of all-cause death.
An AIDS diagnosis and advanced liver fibrosis independently raised the risk of all-cause death in a cohort of 387 Spanish patients coinfected with HIV and hepatitis C virus (HCV). End-stage liver disease and non-AIDS cancer were the leading causes of death.
Coinfection with HIV and HCV is common in many parts of the world because the viruses share transmission routes. Researchers continue to analyze how infection and treatment of one virus affects the course of disease with the other.
Researchers in Barcelona assessed factors associated with overall mortality and liver decompensation in 387 consecutive HIV/HCV-coinfected patients attending an outpatient clinic between January 1997 and December 2007 who had a liver biopsy and met criteria for interferon-based HCV therapy. Follow-up continued every 6 months from liver biopsy until death or December 2008. Median follow-up was 6.2 years (interquartile range 3.5 to 9.2).
Median age at biopsy was 38 years, and almost three quarters of cohort members (73%) were men. Just over one quarter of study participants (28%) had advanced (F3-F4) fibrosis. Most people (92%) were taking combination antiretroviral therapy (ART), 72% had an HIV load below 400 copies/mL, and 21% had a previous AIDS diagnosis. Nadir CD4 count averaged 207 cells/µL and current CD4 count 556 cells/µL.
Almost half of these people (48%) received HCV therapy during follow-up, and 33% achieved a sustained virologic response. Overall mortality measured 1.17 per 100 patient-years and liver decompensation or liver-related death stood at 0.72 per 100 patient-years. End-stage liver disease accounted for 9 of 28 deaths (32%) and non-AIDS cancer for 6 of 28 (21%).
Mortality was significantly greater in patients who did not receive HCV therapy than in those who did (2.04 versus 0.44 per 100 patient-years, P = 0.003). Advanced fibrosis nearly quadrupled the risk of death (hazard ratio 3.75, 95% confidence interval 1.69 to 8.26), and a prior AIDS diagnosis tripled the risk (hazard ratio 3.04, 95% confidence interval 1.36 to 6.81).
The researchers propose that “HIV/HCV-coinfected patients with poor predictors of survival are candidates for intensive clinical management.”
By Mark Mascolini
Source: Ramon Sanmartin, Elena de Felipe, Jordi Tor, Arantza Sanvicens, Eva Barluenga, Elisenda Martinez, Robert Muga, Antoni Jou, Isabel Ojanguren, Juan José López, Bonaventura Clotet, Cristina Tural. Effect of liver fibrosis on long-term mortality in HIV/hepatitis C virus-coinfected individuals who are evaluated to receive interferon therapies in the highly active antiretroviral therapy era. AIDS Research and Human Retroviruses. 2012; 28: 1235-1243.
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