Clinical outcomes in persons coinfected with HIV and HCV: Impact of HCV treatment

Abstract

Background Hepatitis C (HCV) cure is associated with changes in lipids and inflammatory biomarkers but its impact on clinical endpoints among treated HIV/HCV coinfected persons is unclear. Methods HIV-positive persons from EuroSIDA with known HCV status after January 2001 were classified into strata based on time-updated HCV-RNA measurements and HCV treatment: HCV antibody negative, spontaneously resolved HCV, chronic untreated HCV, cured HCV (HCV-RNA-negative), HCV treatment failures (HCV-RNA-positive). Poisson regression compared incidence rates between HCV groups for end-stage liver disease (ESLD; including hepatocellular carcinoma [HCC]), non-AIDS defining malignancy (NADM; excluding HCC) and cardiovascular disease (CVD). Results 16618 persons were included (median follow-up 8.3 (interquartile range 3.1–13.7) years). There were 887 CVD, 902 NADM and 436 ESLD events; crude incidence rates/1000 person-years follow-up (95% confidence interval [CI]) were 6.4 (6.0–6.9) CVD, 6.5 (6.1–6.9) NADM and 3.1 (2.8–3.4) ESLD. After adjustment, there were no differences in incidence rates of NADM or CVD across the five groups. HCV-negative individuals (adjusted incidence rate ratio [aIRR] 0.22 95% CI 0.14–0.34) and those with spontaneous clearance (aIRR 0.61; 95% CI 0.36–1.02) had reduced rates of ESLD compared to cured individuals. Persons with chronic untreated HCV infection (aIRR 1.47; 95% CI 1.02–2.13) or treatment failure (aIRR 1.80; 95% CI 1.22–2.66) had significantly raised rates of ESLD compared to those cured. Conclusions Incidence of NADM or CVD was independent of HCV group whereas those cured had a substantially lower incidence of ESLD, underlining the importance of successful HCV treatment for reducing ESLD.

The hepatitis C cascade of care in HIV/hepatitis C virus coinfected individuals in Europe: regional and intra-regional differences

“…Data on anti-HCV IgG, HCV-RNA, HCV genotype and subtype, liver fibrosis stage, and HCV treatment are collected for participants at enrolment and annually thereafter. Detailed information on the EuroSIDA study has been published elsewhere [12,16].…”

Influence of hepatitis C virus co-infection and hepatitis C virus treatment on risk of chronic kidney disease in HIV-positive persons

“…We were not able to adjust for duration of HCV infection which may be an important confounder. As in a previous study [38] , we chose not to define SVR according to treatment guidelines [21] in part due to differences between the many centres in EuroSIDA in frequency of HCV-RNA monitoring following treatment.…”

Editorial: HIV and Viral Co-infections

“…Another important example relates to HIV and viral hepatitis viruses co-infection, in which a higher risk for both progression to AIDS and progression to end stage liver disease is observed (Soares et al, 2014;Mocroft et al, 2020). Although there are many published articles on coinfections such as HIV-HCV and HIV-HBV, many aspects of the interaction between HIV and other simultaneous viral infections remain obscure.…”