HIV-HCV
Coinfected Individuals and Those with HIV-HBV-HCV Triple Infection Have a Higher
Risk of Death in the HAART Era By
Liz Highleyman  HIV
positive individuals with chronic hepatitis
B virus (HBV) and hepatitis C virus (HCV)
coinfection tend to experience more rapid liver disease progression than HIV negative
people, but use of HAART and
well-preserved or recovered immune function are associated with better outcomes.
Nevertheless,
people with HIV-HCV coinfection,
as well as those with HIV-HBV-HCV
triple infection, have a higher risk of death, despite the availability of effective
combination antiretroviral therapy
(ART), according to a study presented at the recent 44th
Annual Meeting of the European Association for the Study of the Liver (EASL 2009)
in Copenhagen.
C. Smit from the HIV Monitoring Foundation in the Netherlands
and colleagues looked at differences in disease progression and death among participants
in the in the Dutch ATHENA national observational HIV cohort.
The present
analysis included 11,181 participants who were at least 18 years old at time of
HIV diagnosis, were tested for both HBV and HCV, and initiated HAART. Patients
positive for hepatitis B surface antigen (HBsAg) were defined as HBV coinfected,
while those positive for HCV antibodies or HCV RNA were defined as HCV coinfected.
Within this group, the vast majority of patients had HIV alone, but 682
(6%) were HIV-HBV coinfected, 769 (7%) were HIV-HCV coinfected, and 112 (1%) were
HIV-HBV-HCV triple-infected.
The investigators compared time from HAART
initiation to death in the 4 groups. Time to death was analyzed using a Cox proportional
hazard model for patients who started HAART, adjusted for age, sex, transmission
risk group, calendar year of HAART initiation, baseline CD4 cell count, and HIV
RNA level.
Results
During a median 6 years of follow-up, a total of 818 study participants (9%) died.
HIV-HCV coinfected and HIV-HBV-HCV triple-infected patients died significantly
faster than HIV monoinfected patients (P < 0.001).
Time to death was similar, however, in HIV-HBV coinfected and HIV monoinfected
participants (P = 0.30).
Compared with HIV monoinfected patients, HIV-HCV coinfected patients (hazard ratio
[HR] 1.50) and HIV-HBV-HCV triple-infected patients (HR 1.86) had a significantly
higher adjusted risk of death than HIV monoinfected individuals.
Again, HIV-HBV coinfected patients did not have an increased risk of death compared
with the HIV monoinfected group (HR 1.19).
Based
on these findings, the investigators conclude, "Although HAART increased
the life expectancy in HIV infected patients, those with a chronic triple infection
of hepatitis B, C and HIV as well as HCV-HIV coinfected patients still have an
increased mortality risk."
Therefore, they recommended, HCV treatment
should be a priority for HIV-HCV coinfected patients.
HIV Monitoring
Foundation, Amsterdam, Netherlands; Internal Medicine and Infectious Diseases,
University Medical Center Utrecht, Utrecht, Netherlands; Imperial College London,
London, UK.
6/2/09 Reference
C
Smit, J Arends, F de Wolf, and IM Hoepelman. Interaction between Hepatitis B and
C in HIV Infected Patients; Risk of Dying among Patients with a Triple Infection.
44th Annual Meeting of the European Association for the Study of the Liver (EASL
2009). Copenhagen, Denmark. April 22-26, 2009.
EASL
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