In contrast to previous study results, hepatocellular carcinoma and decompensated cirrhosis rates were similar between patients coinfected with hepatitis C and HIV and those with hepatitis C alone, according to data.
“In the period before combination antiretroviral therapy (cART), it was widely observed that HIV/HCV coinfected patients suffered from faster progression of liver fibrosis compared to HCV monoinfected patients, resulting in increased rates of cirrhosis and decompensation of liver disease,” Dominique Salmon-Ceron, MD, PhD, from the Paris Center University Hospital in France, and colleagues wrote. “Because of well-tolerated and very efficient cART and easy access to anti-HCV therapies, the risk of LD and HCC observed in HIV/HCV coinfected patients is no longer higher than that observed in HCV monoinfected patients.”
Salmon-Ceron and colleagues enrolled 175 patients with HIV/HCV coinfection and 1,253 patients with HCV, all of whom also had cirrhosis. Median follow-up was similar between the coinfected group (55.7 months) and the monoinfected group (59.3 months).
During the study, the rates of HCC (8.5% vs. 13.2%; subharzard ratio = 0.63; 95% CI, 0.35-1.13) and decompensation (12.8% vs. 15.6%; SHR = 0.81; 95% CI, 0.49-1.33) did not differ between the coinfected and monoinfected groups after adjusting for 5-year cumulative incidence. Similarly, median delays for occurrence of HCC (36.6 vs. 32.4 months) and decompensation (30.1 vs. 35.5 months) were similar.
However, patients with HIV/HCV coinfection were younger at the time they developed HCC (52.9 vs. 61.8 years) and more severe cases of HCC reflected by larger main tumors sizes (P = .023) compared with the monoinfected group.
Overall crude mortality rate (12.9% vs. 10.8%; SHR = 1.11; 95% CI, 0.72-1.72), crude liver-related mortality rates (5.1% vs. 5.4%) and nonliver-related rates (6.5% vs. 4.7%) at 5 years did not differ between the coinfected and monoinfected groups.
While coinfection did not differ from monoinfection in most analyses, HIV/HCV coinfected did present a higher risk for overall mortality (SHR = 1.88; 95% CI, 1.15-3.06) and nonliver-related mortality (SHR = 2.44; 95% CI, 1.18-5.07) after adjusting for age, compared with HCV monoinfection.
Salmon-Ceron and colleagues explained that the factors most likely to explain these results were the availability and efficacy of cART and direct-acting antivirals, which provide improved outcomes. Additionally, the persistent intravenous drug use and excessive alcohol consumption often observed in patients with HIV and HCV may have affected the severity of some conditions.
“The fact that incidence of liver complications has become similar in both populations is a major result,” the researchers wrote. “Current guidelines can apply to both populations, and the only specificity of HIV/HCV co-infection is the higher risk of drug-drug interaction between DAAs and cART.” – by Talitha Bennett
Disclosures: The authors report no relevant financial disclosures.