Drinking three or more cups of coffee a day halves the risk of dying for people with HIV/HCV co-infection

Drinking three or more cups of coffee a day halves the risk of death from any cause for people with HIV/hepatitis C virus (HCV) co-infection, French investigators report in the Journal of Hepatology. The protective effect of coffee consumption observed in the study was much larger than the 14% reduction in mortality observed in the general population.

“In this large prospective nationwide cohort of patients co-infected with HIV-HCV followed-up in French hospital departments, we found that elevated coffee consumption had an independent protective effect on all-cause mortality risk,” write the authors. “This is the first time such an association has been found in a population at high risk of death because of the double burden of two concomitant diseases and associated conditions.”

People with HIV/HCV co-infection are especially vulnerable to the development of liver disease and liver disease is now the leading cause of death in this group of people.

New direct-acting antiviral agents can cure HCV in most people. However, access to them is often limited. Moreover, even when people are cured, they may still have an increased risk of death due to accelerated ageing and its associated complications.

Coffee consumption is already known to have considerable health benefits.

In particular, coffee contains caffeine and polyphenols which have hepato-protective properties. Research has already shown that people with HIV/HCV co-infection with elevated coffee consumption – three or more cups daily – have a reduced risk of insulin resistance and improved liver enzyme levels.

In the general population, drinking coffee has been associated with a 13-14% reduction in all-cause mortality, as well as a reduced risk of cancer and diabetes.

French investigators wanted to see if elevated coffee consumption similarly reduced mortality risk in people with HIV/HCV co-infection.

Coffee consumption was assessed at baseline in 1028 people who received care at 21 treatment centres across France. Data on all-cause mortality were collected over five years of follow-up.

Participants had a median age of 49 years and most were male. Just less than two-thirds had a history of injecting drug use. At the end of follow-up, 53% had not started HCV therapy. Of those who were treated, 24% had a sustained virological response. Almost all the participants (95%) were taking antiretroviral therapy and 83% had an undetectable viral load.

Elevated coffee consumption (at least three cups each day) was reported by 27% of individuals.

People were followed for a median of five years and contributed a total of 4700 person-years of follow-up. There were 77 deaths, a mortality rate of 1.64/100 person-years. Principal reasons for death were HCV-related causes (43%), AIDS/HCV-related cancer (14%), cardiovascular disease (4%), overdose (4%) and suicide (4%).

After controlling for potential confounders (including severe fibrosis, alcohol consumption and HCV treatment status), the researchers found that drinking at least three cups of coffee a day halved the risk of all-cause mortality (HR = 0.5; 95% CI, 0.3-0.9, p = 0.032).

“There is growing evidence for the hepato-protective role of coffee intake in patients with liver disease, including patients co-infected with HIV/HCV,” comment the investigators. “Coffee intake has been associated with a reduced risk of fibrosis and cirrhosis, and with a reduced risk of death in patients with cirrhosis, even after transplantation.”

HCV treatment that resulted in a cure reduced mortality risk by 80% (p = 0.011), with treatment not achieving a cure reducing the risk of all-cause mortality by 60% (p = 0.036).

“Our findings indicated that elevated coffee consumption has a protective effect on all-cause mortality in patients with HIV-HCV, a population at specific risk of end-stage liver disease and greater risk of cardiovascular diseases and cancer,” conclude the authors. “Further research will help to better elucidate the causal mechanisms of this relationship and reveal whether polyphenols contained in coffee are also implicated.”