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HCV associated with kidney disease, osteoporosis in HIV

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January 9, 2017

Hepatitis C virus seropositivity was associated with an increased risk for osteoporosis and kidney disease in patients with HIV, but infection was not associated with other nonliver related conditions, according to researchers in Switzerland.

“With the advent of direct-acting antivirals offering high cure rates within 12-24 weeks, the landscape of HCV treatment has changed dramatically. … Many studies evaluated the association between HCV seropositivity and nonliver related diseases,” Helen Kovari, MD, of the division of infectious diseases and hospital epidemiology at University Hospital Zurich, and colleagues wrote. “In order to assess the role of ongoing viral replication independent of behavior and social characteristics associated with HCV exposure, it is important to investigate the contribution of HCV viremia on extrahepatic morbidity and mortality.”

Kovari and colleagues enrolled patients who had participated in the Swiss HIV Cohort Study, an ongoing prospective cohort study that has observed HIV–infected adults since 1988. They compared 2,503 HCV seropositive patients with an equal number of seronegative patients, as well as comparing HCV–viremic and nonviremic patients.

Researchers observed that 540 patients had spontaneous virologic clearance. Another 345 were treated and achieved SVR, while 281 were treated but did not achieve SVR. Mean follow-up was 8.2 years.

Seropositive patients experienced an increased risk for liver disease compared with seronegative patients (adjusted IRR = 6.29; 95% CI, 3.52-11.22) and liver-related death (aIRR = 8.24; 95% CI, 3.61-18.83), as well as kidney disease (aIRR = 2.43; 95% CI, 1.11-5.33) and osteoporosis or fracture (aIRR = 1.43; 95% CI, 1.03-2.01).

However, researchers reported that seropositive patients were not at an increased risk for nonliver-related death (aIRR = 0.9; 95% CI, 0.68-1.21), diabetes (aIRR = 1.27; 95% CI, 0.83-1.93), cardiovascular disease (aIRR = 0.9; 95% CI, 0.6-1.34), non-AIDS malignancy (aIRR = 1.07; 95% CI, 0.75-1.52) or HIV CDC stage B or stage C events (aIRR = 1.12; 95% CI, 0.79-1.6).

“We conclude that HCV–exposed HIV–positive individuals have an increased risk of kidney disease and bone-related events, which does not seem to be related to persistent viral replication,” the researchers wrote. “In addition to a significant decrease of liver-related disease and death, therapeutic viral eradication leads to a reduction of diabetes mellitus. Prospective large-scale cohort collaborations are needed to further describe the impact of HCV eradication with direct-acting antivirals on nonliver related morbidity and mortality.”

In an accompanying editorial, Vincent Lo Re III, MD, of the division of infectious diseases, department of medicine at the Penn Center for AIDS Research, University of Pennsylvania, called the study “a model for studies on this topic.”

Vincent Lo Re III, MD
Vinent Lo Re III

Lo Re said the findings “suggest that behavioral factors associated with HCV infection might be more important contributors to the development of renal and bone disease among coinfected patients than HCV viremia-related mechanisms. Specific cohorts, or preferably cohort collaborations, that include large samples of direct-acting antiviral-treated patients with long-term follow-up are needed to determine the impact of successful treatment with these new regimens on extrahepatic diseases among HIV/HCV patients.” – by Andy Polhamus

 

Disclosures: Kovari reports grants from Gilead Sciences and Merck. Lo Re reports grants to the University of Pennsylvania from AstraZeneca. Please see the full study for a list of all other authors’ relevant financial disclosures.

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