HIV/Hepatitis C Coinfection Increases Risk of Liver Events and Death

According to a new study, hepatitis C increases the risk for liver and non-liver related disease and death in HIV-infected patients.

The study included 2503 HIV-infected patients coinfected with hepatitis C (345 of which were treated with sustained virologic response) and 2503 HIV-infected patients who did not have hepatitis C. Researchers used Poisson regression models to assess the differences between the groups. The mean follow-up was 8.2 years.
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In HCV-seropositive patients, researchers observed 107 liver events, 41 kidney events, 230 cases of osteoporosis/fractures, 82 cases of diabetes mellitus, 114 cardiovascular events, 119 non-AIDS malignancies, 162 Centers for Disease Control and Prevention HIV category B/C events, 106 liver-related deaths, and 227 non-liver related deaths.

In HCV-seronegative patients, researchers observed 18 liver events, 14 kidney events, 121 cases of osteoporosis/fractures, 94 cases of diabetes mellitus, 129 cardiovascular events, 147 non-AIDS malignancies, 126 Centers for Disease Control and Prevention HIV category B/C events, 10 liver-related deaths, and 218 non-liver related deaths.

Overall, patients with HIV and hepatitis C had an increased risk of liver events, liver-related deaths, kidney events, and osteoporosis/fractures. HCV-seropositive patients not treated with sustained virologic response had a higher risk of liver events, liver-related death, and diabetes mellitus compared to HCV-seropositive patients treated with sustained virologic response.

Researchers found similar but not statistically significant differences between untreated HCV RNA-positive patients and those with sustained virologic response.

“We conclude that HCV-exposed, HIV-infected individuals have an increased risk of kidney disease and bone-related events that does not seem to be related to persistent viral replication. 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 non-liver-related morbidity and mortality,” the researchers concluded.

—Melissa Weiss

Reference:

Kovari H, Rauch A, Koutos R, et al. Hepatitis C infection and the risk of non-liver-related morbidity and mortality in HIV-infected persons in the Swiss HIV cohort study [published online January 18, 2017]. Clinical Infectious Diseases. doi:https://doi.org/10.1093/cid/ciw809.