Trend Watch

Liver Disease Persists in HIV/HCV Coinfection Despite Antiretroviral Therapy

Patients coinfected with HIV and hepatitis C virus have higher rates of liver compensation compared with patients with hepatitis C virus monoinfection, despite the use of antiretroviral therapy, according to recent study results.

Researchers used patient health records to compare the incidence of hepatic decompensation between 4,280 coinfected patients who recently initiated ART and 6,079 HCV-monoinfected patients who received care between 1997 and 2010. All patients had detectable HCV RNA and were HCV treatment-naive.

At 10 years, the incidence of hepatic decompensation was greater among coinfected patients than monoinfected patients (see Chart). Even after controlling for death as a potential confounder, coinfected patients on ART had a higher rate of decompensation (HR=1.56; 95% CI, 1.31-1.86). Coinfected patients with HIV RNA levels <1,000 copies/ml  still  had higher rates of hepatic decompensation than monoinfected patients (HR=1.44; 95% CI, 1.05-1.99)

Factors associated with higher rates of decompensation among HIV/HCV coinfected patients included advanced hepatic fibrosis, severe anemia, diabetes and race other than black.

Additional analyses indicated that death was twice as common among coinfected patients vs. monoinfected patients, with HIV/AIDS (46.3%) identified as the most common underlying cause. Liver disease (20.1%) was the most common cause of death in monoinfected patients.

“Our results suggest that serious consideration should be given to initiating hepatitis C treatment in patients coinfected with HIV and hepatitis C — particularly among those with advanced liver fibrosis or cirrhosis — in order to try to reduce the risk of serious, potentially life-threatening liver complications,” Vincent Lo Re III, MD, from the Penn Center for AIDS Research at University of Pennsylvania, said in a press release.

Source: Lo Re III V. Ann Intern Med. 2014.

Patients coinfected with HIV and hepatitis C virus have higher rates of liver compensation compared with patients with hepatitis C virus monoinfection, despite the use of antiretroviral therapy, according to recent study results.

Researchers used patient health records to compare the incidence of hepatic decompensation between 4,280 coinfected patients who recently initiated ART and 6,079 HCV-monoinfected patients who received care between 1997 and 2010. All patients had detectable HCV RNA and were HCV treatment-naive.

At 10 years, the incidence of hepatic decompensation was greater among coinfected patients than monoinfected patients (see Chart). Even after controlling for death as a potential confounder, coinfected patients on ART had a higher rate of decompensation (HR=1.56; 95% CI, 1.31-1.86). Coinfected patients with HIV RNA levels <1,000 copies/ml  still  had higher rates of hepatic decompensation than monoinfected patients (HR=1.44; 95% CI, 1.05-1.99)

Factors associated with higher rates of decompensation among HIV/HCV coinfected patients included advanced hepatic fibrosis, severe anemia, diabetes and race other than black.

Additional analyses indicated that death was twice as common among coinfected patients vs. monoinfected patients, with HIV/AIDS (46.3%) identified as the most common underlying cause. Liver disease (20.1%) was the most common cause of death in monoinfected patients.

“Our results suggest that serious consideration should be given to initiating hepatitis C treatment in patients coinfected with HIV and hepatitis C — particularly among those with advanced liver fibrosis or cirrhosis — in order to try to reduce the risk of serious, potentially life-threatening liver complications,” Vincent Lo Re III, MD, from the Penn Center for AIDS Research at University of Pennsylvania, said in a press release.

Source: Lo Re III V. Ann Intern Med. 2014.