Written by Mark Mascolini
Chronic hepatitis C virus (HCV) infection—but not cleared HCV infection—boosted the risk of death 50 percent in a US group of people with AIDS.
People with AIDS have a 5 times higher mortality than non-AIDS patients, but few studies of HIV populations in the current antiretroviral era focus solely on those with AIDS. The Longitudinal Studies of the Ocular Complications of AIDS (LSOCA) includes only people with AIDS, and follow-up has continued for a median of more than six years. The LSOCA group is similar in age, race, and gender to the entire US AIDS population, except that it has a lower percentage of people with a history of injection drug use.
When combination antiretroviral therapy began to spare people from AIDS and prolong lives, a higher proportion of HIV-positive people began to die of liver disease, often caused by HCV infection. LSOCA investigators planned this analysis to determine the impact of HCV infection on mortality in people with AIDS.
The study included 337 people with detectable HCV RNA (indicating chronic HCV infection), 91 people with HCV antibodies but no HCV RNA (indicating cleared infection), and 1597 people with no HCV markers. During a follow-up of 6.1 years, 558 people died.
Statistical analysis that accounted for demographics and other death risk factors indicated that people with chronic HCV infection had a 50 percent higher risk of death than people with no HCV markers (relative risk [RR] 1.5, 95 percent confidence interval [CI] 1.2 to 1.9, P = 0.001). But people with cleared HCV infection did not have a higher death risk than people with no HCV markers (RR 0.9, 95 percent CI 0.6 to 1.5, P = 0.82).
Among AIDS patients with chronic HCV, 20.4 percent of deaths were related to liver disease, compared with 3.8 percent of deaths in AIDS patients without HCV. Almost 30 percent of people with chronic HCV had never been given a diagnosis of HCV infection.
“Our results underscore the urgency of efforts to screen AIDS patients for HCV and to make sure that the test results and their implications are clearly communicated,” the LSOCA team concludes.
Increased screening and treatment are especially urgent now that “a new era of HCV treatment with direct acting antiviral drugs has just begun.
Source: Andrea D. Branch, Mark L. Van Natta, Marie-Louise Vachon, Douglas T. Dieterich, Curtis L. Meinert, Douglas A. Jabs. Mortality in hepatitis C virus-infected patients with a diagnosis of AIDS in the era of combination antiretroviral therapy. Clinical Infectious Diseases. 2012; 55: 137-144.
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Written by Mark Mascolini on behalf of the International AIDS Society.