HCV type and IL28B gene affect risk of death in HCV/HIV-positive
The findings may have consequences for the management of HIV/HCV-coinfected individuals.
Hepatitis C virus (HCV) genotype, IL28B CC genotype, and a detectable HIV load independently raised the risk of all-cause mortality in HCV/HIV-coinfected people in Denmark. A higher CD4 count lowered the risk of death.
Researchers at several Danish centers collaborated to test the hypothesis that HCV load and genotype may influence all-cause mortality in people coinfected with HCV and HIV. They used a time-updated multivariate analysis to compare mortality rates in an observational prospective cohort study.
The study focused on 264 consecutive HCV/HIV-coinfected people, 118 of whom died during 1143 person-years at risk for an overall mortality of 10 per 100 person-years at risk (95% confidence interval [CI] 8 to 12).
Multivariate analysis adjusted for sex, age, HIV exposure group, CD4 cell count, HIV RNA, HCV genotype, and interleukin (IL)-28B genotype identified the following factors associated with risk of death, at the noted adjusted mortality rate ratios (aMRR) (and 95% CIs):
Raised risk of all-cause mortality: • 10-fold increase in HCV load: aMRR 1.30 (1.10 to 1.54) • HCV genotype 3 vs 1: aMRR 1.83 (1.12 to 2.98) • Detectable vs undetectable HIV RNA: aMRR 3.14 (1.37 to 7.17) • IL28B CC vs TT genotype: aMRR 1.54 (0.89 to 3.82)
Lowered risk of all-cause mortality: • Every 50-cell higher CD4 count between 0 and 200 cells/μL: aMRR 0.59 (0.48 to 0.72) • CD4 count above 200 cells/μL: aMRR 0.90 (0.82 to 0.98)
The researchers suggest their findings “may have consequences for the management of HIV-HCV-coinfected individuals.”
By Mark Mascolini
Source: Louise Nygaard Clausen, Karen Astvad, Steen Ladelund, Mette Vang Larsen, Kristian Schønning, Thomas Benfield. Hepatitis C viral load, genotype 3 and interleukin-28B CC genotype predict mortality in HIV and hepatitis C-coinfected individuals. AIDS. 2012; 26: 1509-1516.
(Downloading the complete article requires a subscription to AIDS or an online payment; the abstract is free.)