Eradication of hepatitis C virus and non‐liver‐related non–acquired immune deficiency syndrome–related events in human immunodeficiency virus/hepatitis C virus coinfection

Abstract

We assessed non‐liver‐related non–acquired immunodeficiency syndrome (AIDS)‐related (NLR‐NAR) events and mortality in a cohort of human immunodeficiency virus (HIV)/hepatitis C virus (HCV)–coinfected patients treated with interferon (IFN) and ribavirin (RBV), between 2000 and 2008. The censoring date was May 31, 2014. Cox regression analysis was performed to assess the adjusted hazard rate (HR) of overall death in responders and nonresponders. Fine and Gray regression analysis was conducted to determine the adjusted subhazard rate (sHR) of NLR deaths and NLR‐NAR events considering death as the competing risk. The NLR‐NAR events analyzed included diabetes mellitus, chronic renal failure, cardiovascular events, NLR‐NAR cancer, bone events, and non‐AIDS‐related infections. The variables for adjustment were age, sex, past AIDS, HIV transmission category, nadir CD4+ T‐cell count, antiretroviral therapy, HIV RNA, liver fibrosis, HCV genotype, and exposure to specific anti‐HIV drugs. Of the 1,625 patients included, 592 (36%) had a sustained viral response (SVR). After a median 5‐year follow‐up, SVR was found to be associated with a significant decrease in the hazard of diabetes mellitus (sHR, 0.57; 95% confidence interval [CI], 0.35‐0.93; P = 0.024) and decline in the hazard of chronic renal failure close to the threshold of significance (sHR, 0.43; 95% CI, 0.17‐1.09; P = 0.075). Conclusion: Our data suggest that eradication of HCV in coinfected patients is associated not only with a reduction in the frequency of death, HIV progression, and liver‐related events, but also with a reduced hazard of diabetes mellitus and possibly of chronic renal failure. These findings argue for the prescription of HCV therapy in coinfected patients regardless of fibrosis stage. (Hepatology 2017;66:344–356).

Risk of diabetes in HIV‐infected patients is associated with cirrhosis but not with chronic HCV coinfection in a French nationwide HIV cohort

“…34 SVR in HCV infected patients has been associated with both regression of severe transaminitis, steatosis, IR and the prevention of DM development. 14,18,19,[34][35][36] In a Spanish cohort of 1625 HIV/HCV coinfected patients treated with IFN and ribavirin, SVR (n = 592) after a median 5-year follow-up was associated with a significant decrease in the hazard ratio for DM (sHR 0.57 [95% CI, 0.35-0.93] P = 0.024). 19 In a Swiss cohort, HCV-treated patients without SVR (n = 281) had a 4-fold higher risk of DM compared to those with SVR (n = 345).…”

“…14,18,19,[34][35][36] In a Spanish cohort of 1625 HIV/HCV coinfected patients treated with IFN and ribavirin, SVR (n = 592) after a median 5-year follow-up was associated with a significant decrease in the hazard ratio for DM (sHR 0.57 [95% CI, 0.35-0.93] P = 0.024). 19 In a Swiss cohort, HCV-treated patients without SVR (n = 281) had a 4-fold higher risk of DM compared to those with SVR (n = 345). 21 Although a history of IFN therapy was reported in high number of patients (n = 2010; 7%), this factor was also not related to DM.…”

“…[15][16][17] Furthermore, a decrease in IR and in the incidence of DM has been observed in HCV-treated patients who achieved sustained viral response (SVR), but results are conflicting. [18][19][20][21] The aim of this study was to determine whether there is an association between chronic hepatitis C and the incidence of DM, and to study the role of factors such as cirrhosis, IFN-based HCV therapy, SVR and chronic hepatitis B infection among patients living with HIV (PLHIV) followed in a large French multicentre cohort in the combination antiretroviral therapy (cART) era (from January 2000 to July 2013). Dat'AIDS is a French multicentre prospective cohort involving 12 large HIV reference centres in France.…”

Mild profile improvement of immune biomarkers in HIV/HCV-coinfected patients who removed hepatitis C after HCV treatment: A prospective study

“…22 , 23 The elimination of HCV infection after HCV therapy (sustained virologic response (SVR)) in HIV/HCV-coinfected patients decreases the risk of clinical events and death. [24][25][26] However, cirrhotic patients who achieve SVR remain at risk of developing hepatocellular carcinoma 27 and extrahepatic cancers. 28 Additionally, reversal of cirrhosis after SVR seems to be a slow process and the alterations of the immune system may persist after achieving SVR, particularly in cirrhotic patients.…”

Drug plasma trough concentrations during treatment with daclatasvir and sofosbuvir are associated respectively with liver impairment and with renal dysfunction in HIV/HCV co-infected patients

“…Achieving sustained virological response (SVR) after treatment is associated to regression of hepatic disease, including fibrosis reduction, as well as to improvement of several comorbid conditions [4][5].…”