For patients with HIV, hepatitis C virus (HVC) coinfection is a significant risk factor for mortality after initiating antiretroviral therapy (ART), according to results published in Clinical Infectious Diseases.
The results also indicated that direct-acting antiretroviral (DAA) drugs are an effective way to reduce mortality in this population.
The study included participants from the Women’s Interagency HIV Study and the Multicenter AIDS Cohort Study, including those who had prevalent HIV or seroconverted during follow-up. All participants were antiretroviral-naïve and AIDS-free prior to their first visit after October 1, 1994. The follow-up period was 10 years or until September 30, 2015.
The researchers used parametric g-computation to estimate the effects of HCV infection and DAA treatment on mortality if participants initiated ART at study entry.
Out of 3056 participants, 58% were women and 18% had HCV infection. Researchers established parameters in which none of the participants with HIV had HCV, the researchers estimated a 10-year all-cause mortality risk of 10.4% (95% CI, 6.0-18.0).
The 10-year mortality risk difference for HCV infection was 4.3% (95% CI, 0.4-8.9) with a risk ratio of 1.4 (95% CI, 1.0-1.9). For participants with HCV who underwent DAA treatment, the risk difference was -3.8% (95% CI, -9.2-0.9), and the risk ratio was 0.8 (95% CI, 0.6-1.1).
“Given our findings, we believe that HIV care providers should make strong efforts to address HCV coinfection in their patients and that policy makers and insurers should expand access to direct-acting antiretroviral [agents] and prioritize HCV interventions for [people living with HIV],” the researchers wrote.
Breskin A, Westreich D, Cole SR, et al. The effects of hepatitis C infection and treatment on all-cause mortality among people living with human immunodeficiency virus [published online October 12, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy588