Mortality rates in patients coinfected with HIV and hepatitis C (HCV), who are treated with HAART, are no different to those seen in HIV monoinfected patients in receipt of HAART, according to a US study published in the 15th January 2003 edition of the journal Clinical Infectious Diseases. Meanwhile a study in the 1st January edition of the same journal has found that few people with HIV/HCV coinfection receive anti-HCV therapy because of other medical, psychiatric or social problems in their lives.
Investigators from the US observational cohort, the HIV Outpatients Study (HOPS), analysed data from 823 patients from three large urban clinics. HIV/HCV coinfection was present in 267 (32.4%), with the remaining 556 (67.6%) being HIV monoinfected.
Participants were followed from January 1996 to June 2001. At baseline, coinfected patients were more likely to have a history of injecting drug use than HIV monoinfected patients, were older, and were more likely to be non-White. In addition, patients with HIV/HCV coinfection had a lower average baseline CD4 count than the HIV monoinfected patients (242 cells/mm3 versus 316 cells/mm3). Average HIV viral load was, however, comparable between the two patient groups (2,414 copies/mL in coinfected patients versus 4,212 copies/mL in HIV monoinfected patients). Duration of observation was longer in the monoinfected group (3.1 versus 2.7 years).
Similar numbers of patients in both groups were treated with HAART (approximately 85%), and received it for an average of 1.9 years. Coinfected patients, however, started HIV therapy later than HIV monoinfected patients, and with a lower CD4 count (164 cells/mm3 versus 231 cells
Coinfected patients were more likely to be unwell, and as a group had more AIDS diagnoses, as well as a higher incidence of kidney disease, cardiovascular disease and abnormal liver function (cirrhosis and raised transaminase levels). A higher proportion of people in the coinfected group died (10.9% versus 6.7%) during follow-up. However, when baseline CD4 count, duration of HAART, and patient age were taken into account, HCV ceased to be associated with an increased risk of death. In addition, the increased incidence of kidney and cardiovascular disease seen in patients with HIV/HCV coinfection ceased to be significant when controlled for age. Of all comorbidities, only liver abnormalities continued to be seen at increased rates amongst coinfected patients, a finding to be expected in this context.
The investigators conclude that although "HCV infection presents special problems for the HIV-infected patient – notably liver disease and associated mortality…after controlling for age and baseline CD4 cell count, this analysis suggests that the receipt of HAART decreases the mortality rate among HIV/HCV coinfected patients. HIV/HCV coinfected patients receiving HAART had similar durations of survival to patients infected with HIV alone when we adjusted for all these factors."
Few coinfected people in the HOPS study were treated with anti-HCV therapy, and a study published in the 1st January 2003 edition of Clinical Infectious Diseases has provided clues on why this may be so. This study found that many people with HIV/HCV coinfection were not considered suitable for treatment because of a range of medical, psychiatric or social factors.
Of 149 coinfected patients at an HIV clinic in Boston, USA, only 30% were judged by their physicians to be candidates for anti-HCV therapy. Issues considered serious enough to prevent treatment being provided included non-adherence and/or failure to attend medical appointments by 23% of patients; drug and alcohol use in 23%; psychiatric illness in 21%; liver disease in 12%; advanced HIV disease in 13%; and for a further 8%, the presence of other medical complications.
Further information on this website
HIV and hepatitis booklet – Information series for HIV-positive people
Tedaldi EM et al. Influence of coinfection with hepatitis C virus on morbidity and mortality due to human immunodeficiency virus infection in the era of highly active antiretroviral therapy. Clinical Infectious Diseases, electronic edition, 15th January, 2003.
Catherine A et al. Hepatitis C virus and human immunodeficiency virus coinfection in an urban population: low eligibility for interferon treatment. Clinical Infectious Diseases 36:97-101, 2003.