Liver disease persists in HIV/HCV coinfected patients despite ART
Patients coinfected with HIV and hepatitis C have higher rates of liver decompensation compared with patients with hepatitis C monoinfection, despite the use of antiretroviral therapy, according to new study results.
HCV occurs in 10% to 30% of HIV-infected patients, according to researchers. Studies have suggested that ART slows the progression of HCV-related liver fibrosis, but rates of hepatic decompensation and other severe liver events among coinfected patients receiving ART have so far remained unclear.
“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, of the Penn Center for AIDS Research at the University of Pennsylvania, said in a press release. “By taking action sooner, we may be able to reduce the risk of advanced liver disease in coinfected patients.”
Vincent Lo Re III
Lo Re and colleagues 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 receiving care between 1997 and 2010. All patients in the study had detectable HCV RNA and were HCV treatment-naive. Hepatic decompensation was determined through diagnoses of ascites, spontaneous bacterial peritonitis or esophageal variceal hemorrhage. The researchers also examined factors associated with developing decompensation.
At 10 years, the incidence of hepatic decompensation was greater among coinfected patients than monoinfected patients (7.4% vs. 4.8%; P<.001). Even after controlling for death as a potential confounder, the researchers discovered that 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 (HR=5.45; 95% CI, 3.79-7.84), severe anemia (HR=2.24; 95% CI, 1.2-4.20), diabetes (HR=1.88; 95% CI, 1.38-2.56) and race other than black (HR=2.12; 95% CI, 1.65-2.72).
Additional analyses indicated that death was twice as common among coinfected patients vs. monoinfected patients (32.9% vs. 15.4%; P<.001), with HIV/AIDS (46.3%) as the most common underlying cause. Liver disease (20.1%) was the most common cause of death in monoinfected patients, according to the researchers.
“Clinicians should address modifiable risk factors and consider treatment of HCV infection in coinfected patients to reduce rates of hepatic decompensation,” the researchers concluded.
Disclosure: See the study for a full list of financial disclosures.