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Clin Infect Dis. 2019 Jul 2. pii: ciz601. doi: 10.1093/cid/ciz601. [Epub ahead of print]

Clinical Outcomes in Persons Coinfected With Human Immunodeficiency Virus and Hepatitis C Virus: Impact of Hepatitis C Virus Treatment.

Author information

1
Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom.
2
Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, and Department of Infectious Diseases, Copenhagen.
3
Department of Infectious Diseases, Rigshospitalet, Copenhagen.
4
Department of Infectious Diseases, Odense University Hospital, Denmark.
5
Department of Infectious Diseases, Royal Free Hospital, London, United Kingdom.
6
Division of Infectious Diseases, Helsinki University Hospital, Finland.
7
Department of Public Health, Centre Hospitalier Universitaire de Nice, France.
8
Division of Infectious Diseases, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University of Munich, Germany.
9
Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Milan, Italy.
10
Vita-Salute San Raffaele University, San Raffaele Scientific Institue, Clinic of Infectious Diseases, Milan, Italy.
11
Hospital de Curry Cabral, Serviço de Doenças Infecciosas, Lisbon, Portugal.
12
Infectious Diseases Service, Hospital Clinic-L'Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain.
13
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
14
Infectious Diseases Department, Karolinska University Hospital, Stockholm, Sweden.
15
Novgorod Centre for Acquired Immunodeficiency Syndrome Prevention and Control, Novgorod the Great, Russia.
16
Samara State Medical University, Russia.
17
Belgrade University School of Medicine, Infectious & Tropical Diseases Hospital, Serbia.
18
Wojewodzki Szpital Zakazny, Warsaw, Poland.
19
Centre of Infectious Diseases, West-Tallin Central Hospital, Tallin, Estonia.
20
Crimean Republican Acquired Immunodeficiency Syndrome Centre, Simferopol.
21
Gilead Sciences Inc., Foster City, California.
22
Department of Medicine, University Hospital Bonn, Germany.

Abstract

BACKGROUND:

A hepatitis C (HCV) cure is associated with changes in lipids and inflammatory biomarkers, but its impact on clinical endpoints among treated human immunodeficiency virus (HIV)/HCV coinfected persons is unclear.

METHODS:

People living with HIV from EuroSIDA with a known HCV status after January 2001 were classified into strata based on time-updated HCV RNA measurements and HCV treatment, as either HCV antibody-negative; spontaneously resolved HCV; chronic, untreated HCV; cured HCV (HCV RNA-negative); or HCV treatment failures (HCV RNA-positive). Poisson regression was used to compare incidence rates between HCV groups for end-stage liver disease (ESLD; including hepatocellular carcinoma [HCC]), non-acquired immunodeficiency virus defining malignancy (NADM; excluding HCC), and cardiovascular disease (CVD).

RESULTS:

There were 16 618 persons included (median follow-up 8.3 years, interquartile range 3.1-13.7). There were 887 CVD, 902 NADM, and 436 ESLD events; crude incidence rates/1000 person-years follow-up were 6.4 (95% confidence interval [CI] 6.0-6.9) for CVD, 6.5 (95% CI 6.1-6.9) for NADM, and 3.1 (95% CI 2.8-3.4) for ESLD. After adjustment, there were no differences in incidence rates of NADM or CVD across the 5 groups. HCV-negative individuals (adjusted incidence rate ratio [aIRR] 0.22, 95% CI 0.14-0.34) and those with spontaneous clearance (aIRR 0.61, 95% CI 0.36-1.02) had reduced rates of ESLD compared to cured individuals. Persons with chronic, untreated HCV infections (aIRR 1.47, 95% CI 1.02-2.13) or treatment failure (aIRR 1.80, 95% CI 1.22-2.66) had significantly raised rates of ESLD, compared to those who were cured.

CONCLUSIONS:

Incidences of NADM or CVD were independent of HCV group, whereas those cured had substantially lower incidences of ESLD, underlining the importance of successful HCV treatment for reducing ESLD.

KEYWORDS:

HIV; cardiovascular disease; end-stage liver disease; hepatitis C; malignancies

PMID:
31504296
DOI:
10.1093/cid/ciz601

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