Outcomes worse with HCV, HIV coinfection

Patients with both hepatitis C and HIV had higher rates of hepatic decompensation regardless of treatment with antiretroviral therapy than those with HCV alone.

Liver Disease
Liver Disease

Patients with hepatitis C virus and HIV coinfection had increased rates of hepatic decompensation regardless of treatment with antiretroviral therapy, compared with those with HCV alone, according to researchers.

Rates of hepatic decompensation were highest among non-black patients, those with diabetes, advanced liver fibrosis and severe anemia, Vincent Lo Re III, MD, MSCE, of the University of Pennsylvania reported in Annals of Internal Medicine.

Although it is common for patients with HIV to be coinfected with HCV, little is known about whether antiretroviral therapy (ART) improves HCV outcomes in these patients.

So Lo Re and collageus set out to compare the incidence of hepatic decompensation between 4,280 ART-treated patients with HIV and HCV coinfection and 6,079 patients with HCV treated at the Veterans Health Administration between 1997 and 2010. They also assessed factors associated with decompensation among co-infected patients receiving ART.

Results indicated that coinfected patients had higher rates of hepatic decompensation vs. monoinfected patients (7.4% vs. 4.8% at 10 years; P<0.001). Rates remained higher even among those who maintained HIV RNA levels less than 1,000 copies/mL (hazard ratio=1.44; 95% CI: 1.05-1.99).

Factors associated with higher rates of hepatic decompensation among coinfected patients included the presence of baseline advanced hepatic fibrosis (HR=5.45; 95% CI: 3.79-7.84), hemoglobin levels <100 g/L (HR=2.24; 95% CI: 1.20-4.20), diabetes (HR=1.88; 95% CI: 1.38-2.56) and nonblack race (HR=2.12; 95% CI: 1.65-2.72).

“Clinicians should address modifiable risk factors and consider treatment of HCV infection in co-infected patients to reduce rates of hepatic decompensation,” the researchers wrote.

Researchers noted a limitation of the observational study was that it included predominantly males.

References

  1. LoRe V. Ann Intern Med. 2014;160(6):369-379.

Disclosure: See the study for a full list of the researcher's relevant financial disclosures.

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