Treatment with HAART is associated with a lower rate of mortality from liver-related causes in individuals coinfected with HIV and hepatitis C virus (HCV), according to a German study published in the November 22nd edition of The Lancet.
Investigators from Bonn examined liver-related deaths in a cohort of 285 patients coinfected with HIV and HCV as part of an observational study, which ran from 1990 to 2002.
The investigators stratified patients according to their anti-HIV treatment history into one of three groups: HAART; dual or mono nucleoside analogue treatment; and no anti-HIV treatment. Data were also gathered on HIV and HCV viral load and CD4 cell count to see if any independent predictors of liver-related mortality could be identified.
Treatment with nucleoside analogues became available to patients in Bonn in 1992, and HAART was first introduced in 1995. In total, 93 patients were treated with HAART, 55 individuals received dual or mono-therapy, and 137 patients took no anti-HIV drugs. None of the patients were treated with interferon either alone or with ribavirin as anti-HCV therapy.
Investigators established that the rate of liver-related mortality was significantly lower in individuals who received HAART (two patient deaths, 0.45 per 100 person-years, p
CD4 cell gain after the initiation of HAART was associated with a significant decrease in the risk of dying from liver related causes (p
The investigators noted that HCV viral loads increased significantly in all three groups of patients, regardless of their anti-HIV treatment histories (p
Severe drug-related liver toxicity occurred in 13.8% of patients taking HAART, and resulted in no patient deaths.
Commenting on their study, the investigators say, “analysis of long-term survival in our cohort of 285 patients with coinfection shows that in addition in improving overall survival, effective antiretroviral therapy also lowers mortality from HCV-associated chronic liver disease.” They added, “thus, we conclude that effective antiretroviral therapy has beneficial effects on the clinical course and outcome of liver disease in patients with HIV and HCV coinfection.”
An editorial in the same edition of The Lancet states that for HIV/HCV coinfected patients, “the risks of hepatoxicity, although real, should not diminish the use of HAART, but should encourage more widespread use of pharmacokinetic testing and development of new agents against HIV-1 that have less effect on liver metabolism.”
NAM information forum
Every month NAM holds an information forum on a key aspect of HIV treatment in central London. The next NAM information forum, on December 1st, will be on HIV and hepatitis coinfection. Dr Mark Nelson from London’s Chelsea and Westminster Hospital will talk about the latest information on hepatitis B and C. Admission is free, and the forum is open to everyone. Click here for more details.
Further information on this website
Hepatitis C - overview
Hepatitis C - factsheet
HIV and hepatitis - booklet in the information for HIV-positive people series (pdf)
Qurishi N et al. Effect of antiretroviral therapy on liver-related mortality in patients with HIV and hepatitis C virus coinfection. The Lancet 362: 1708 – 1713, 2003
Alatrakchi N et al. A tale of two viruses: hepatitis C in the age of HAART. The Lancet 362: 1687 – 88, 2003.