 Elevated
Risk of Hepatitis-related Death in HIV-HCV Coinfected Drug Users
By
Liz Highleyman
A growing body of research indicates that HIV-HCV
coinfected patients tend to experience more rapid liver disease progression
compared with HCV monoinfected individuals; some
studies, however, suggest this may not be the case in coinfected people with well-controlled
HIV disease and well-preserved immune function.
Liver
disease has become an increasingly significant cause of morbidity and mortality
in HIV positive patients as they survive longer
due to effective antiretroviral therapy and are less likely to die of directly
AIDS-related causes.
As reported in the February 1, 2008, Journal of
Acquired Immune Deficiency Syndromes, Dutch researchers compared overall and
cause-specific mortality in HIV-HCV coinfected and HCV monoinfected drug users
and those infected with neither virus. A total of 1295 participants in the Amsterdam
Cohort Study followed between 1985 and 2006 were included in the analysis. Cause-specific
hazard ratios (HRs) were estimated for the pre-HAART (before 1997) and HAART (1997
onward) eras.
•
The risk of dying decreased
for most causes of death after 1997, but the decrease was not the same in the
3 groups.
•
Among HIV-HCV coinfected
drug users, the risk of hepatitis/liver-related death did not substantially change
over time (HR 0.87; 95% CI 0.21-3.58), but the risk of AIDS-related mortality
decreased.
•
In the HAART era, compared
with HCV monoinfected drug subjects, coinfected drugs users were at increased
risk of dying from:
•
Hepatitis/liver-related
disease (HR 7.15; 95% CI 1.98-25.8);
•
Other natural causes
(HR 3.09; 95% CI 1.41-6.79);
•
"Non-natural"
causes (including, e.g., accidents, suicide) (HR 2.30; 95% CI 1.07-4.95).
Conclusion
In
conclusion, the authors wrote, "HCV-HIV coinfected drug users remain at increased
risk of dying from hepatitis/liver-related death in the HAART era compared with
HCV monoinfected drug users."
"This risk did not change in HCV-HIV
coinfected drug users after HAART was introduced," they added, "suggesting
that in the HAART era, HIV continues to accelerate HCV disease progression."
Health
Service of Amsterdam, the Netherlands; Academic Medical Center, Amsterdam, the
Netherlands; Center for Infectious Diseases Control, Bilthoven, the Netherlands. 1/29/08 Reference
C
Smit, C van den Berg C, R Geskus, and others. Risk of Hepatitis-Related Mortality
Increased Among Hepatitis C Virus/HIV-Coinfected Drug Users Compared With Drug
Users Infected Only With Hepatitis C Virus: A 20-Year Prospective Study. JAIDS
47(2): 221-225. February 1, 2008. |
