SUMMARY: HIV/HCV coinfected individuals with more advanced fibrosis have shorter survival than those with less liver damage, but treatment with interferon-based therapy reduces mortality risk, according to findings from a Spanish study presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010) recently held in Boston.

By Liz Highleyman

HIV positive people with chronic hepatitis C virus (HCV) infection tend to experience more rapid liver disease progression than those with HCV alone, but the influence of coinfection on mortality has not been extensively studied.

R. SanMartin and colleagues from University Hospital Germans Trias i Pujol in Badalona conducted a study to evaluate factors predicting death in a cohort of HIV/HCV coinfected patients who received liver biopsies between 1997 and 2006 and were followed prospectively.

The analysis included 363 coinfected participants recruited from a tertiary teaching hospital. About three-quarters were men, the mean age was 38 years, and most had a history of injection drug use. Just over half had hard-to-treat HCV genotype 1 and about 30% had advanced liver fibrosis (stages F3-F4).

At study entry participants were required to have stable HIV infection without co-morbid conditions or active illicit drug or heavy alcohol use. More than 90% were on combination antiretroviral therapy (ART) and 70% had HIV viral load < 200 copies/mL. The current median CD4 cell count was high, at 556 cells/mm3, but the CD4 nadir (lowest-ever level) was 207 cells/mm3, and about 20% had been diagnosed with AIDS.

Participants were monitored every 6 months for an average follow-up duration of 4.5 years.

Results

	114 patients received interferon-based hepatitis C treatment.
	24% achieved sustained virological response (SVR).
	Patients with advanced-to-severe (F3-F4) fibrosis were on average older (39 vs 38 years) and had lower CD4 counts (495 vs 580 cells/mm3) than those with absent-to-moderate (F0-F2) fibrosis.
	23 coinfected patients died due to any cause during follow-up.
	The main causes of death were end-stage liver disease and cancer.
	The overall mortality rate was 1.41 per 100 person-years, but varied according to fibrosis stage and hepatitis C treatment status:
	F3-F4: 2.86 per 100 person-years; F0-F2: 0.85 per 100 person-years; Interferon-based therapy: 0.89 per 100 person-years; No hepatitis C treatment: 1.77 per 100 person-years.
	In a multivariate analysis, the only independent risk factor for death was higher liver fibrosis stage at baseline (F3-F4 relative risk 3.48, or about a 3.5-fold higher risk).
	Interferon-based treatment was associated with a lower rate of death (relative risk 0.42, or about a 60% decrease in risk).

Based on these results, the investigators concluded, "Among all HIV and HCV related characteristics, liver fibrosis stage is the only independent factor associated with death [due to] any cause. Patients who received interferon had also lower mortality rates."

Investigator affiliation: Hosp. Univ. Germans Trias i Pujol, Badalona, Spain.

9/28/10

Reference
R. SanMartin, E Martinez, E De Felipe, and others. Impact of Liver-Fibrosis Stage on Mortality in a Cohort of HIV/HCV with a Mean Follow-Up of 4.5 Years. 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010). Boston, September 12-15, 2010. Abstract H-1672.