Sustained virologic response to the hepatitis C virus (HCV) in patients co-infected with HCV and HIV is associated with a lowered risk for diabetes and mortality, and patients treated with interferon (INF) who do not achieve sustained virologic response, show a reduced mortality risk compared with nontreated patients, according to a study published in the European Journal of Clinical Microbiology & Infectious Diseases.
This study was designed to assess how sustained virologic response may affect the occurrence of diabetes, chronic kidney disease, and cardiovascular disease in a cohort of 1676 patients co-infected with HIV and HCV (median age 40.22 years old, 72.67% men) who were selected from the Italian Management of Standardized Evaluation of Retroviral HIV Infection and divided into 4 groups: exposure to INF without sustained virologic response, exposure to INF with sustained virologic response, spontaneous HCV clearance, and untreated viremic patients. Cox regression and Kaplan-Meier curves were used to assess associations between sustained virologic response/INF strata and extrahepatic complication incidence.
The overall incidence per 1000 person-years of follow-up was 10.13 (95 % CI, 8.20-12.37) for diabetes, 5.32 (95 % CI, 3.99-6.98) for chronic kidney disease, 6.79 (95 % CI, 5.26-8.65) for cardiovascular disease, and 13.49 (95 % CI, 11.29-16.0) for death. Patients who were exposed to INF and attained sustained virologic response showed the lowest probability of diabetes occurrence and death (P =.033 and P <.0001, respectively). The pooled probability of diabetes (P =.0059), cardiovascular disease (P =.04), and death (P <.0001), but not kidney disease (P =.150), was significantly lower in patients exposed to INF who attained sustained virologic response, and in those achieving spontaneous clearance compared with the treated and untreated viremic patients. Overall, the probability of diabetes (P =.046) and death (P <.0001), but not kidney disease (P =.86) and cardiovascular disease (P =.2), was significantly lower in patients exposed to INF compared with patients who were not exposed to INF, regardless of viremic status. Researchers noted that diabetes was significantly associated with a 2-fold increased mortality risk in patients with HIV/HCV co-infection.
Study investigators concluded that “[t]hese results warrant further investigations to better characterize the role of [sustained virologic response] as an independent prognostic factor for extrahepatic events in HIV/HCV-coinfected patients.”
Disclosures: Several authors declare affiliations with the pharmaceutical industry. See the reference for a full list of disclosures.
Leone S, Prosperi M, Costarelli S, et al. Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response. Eur J Clin Microbiol Infect Dis. 2016;35(9):1511-1520.