Impact of hepatitis C virus antibody positivity on mortality and causes of death in people living with HIV in Georgia

Abstract

Hepatitis C co-infection in people living with HIV (PLWH) is common in Georgia. Antiretroviral therapy (ART) is widely available in the country since 2004, and from 2011, patients have unlimited access to hepatitis C virus (HCV) treatment. A retrospective nationwide cohort study included adult PLWH diagnosed between 2004–2016, who were followed up until 31 December 2017. Predictors of mortality were assessed in Cox proportional hazards regression model. A total of 4560 persons contributed 22,322 person-years (PY) of follow-up, including 2058 (45.1%, 10,676 PY) anti-HCV+ patients. After the median 4.1 years of follow-up, 954 persons died, including 615 anti-HCV+ patients. Persons with HCV had higher overall mortality compared to HIV monoinfection (5.76/100 PY vs. 2.91/100 PY, p < 0.0001). In multivariable analysis, anti-HCV positivity was significantly associated with mortality (adjusted hazard ratio: 1.42, 95% CI: 1.09–1.85). Among anti-HCV+ persons, liver-related mortality due to viral hepatitis before the availability of HCV therapy (2004–2011) was 2.11 cases per 100 PY and this decreased to 0.79 cases per 100 PY after 2011 (p < 0.0001). AIDS remained the leading cause of death prior to and after 2011. Wide availability of ART and anti-HCV therapy translated into a significant decline in mortality including due to liver-related causes. Improving earlier diagnosis will decrease excess AIDS-related mortality among people living with HIV/HCV co-infection.

Causes and outcomes of hospitalizations among people living with HIV in Georgia’s referral institution, 2012–2017

“…We have previously documented a decrease in liver-related mortality in HIV/HCV coinfected patients following universal availability of HCV treatment, although all-cause mortality in coinfected patients remained higher because of AIDS-related causes than mono-infection. 32 Analysis of factors associated with mortality in multivariate analysis showed that severe AIDS admissions were significantly associated with increased odds of mortality compared to non-AIDS admissions as well as hospitalizations due to moderate and mild AIDS conditions. Other factors associated with higher mortality further emphasize contribution of late presentation, including shorter period between HIV diagnosis and hospitalizations, low CD4 cell count, and no history of ART prior to hospitalization.…”