explore this issue, Ting-Yi Chen and colleagues performed
a meta-analysis to estimate the effect of HCV
coinfection on HIV disease progression and overall
mortality in the pre-HAART and HAART eras.
investigators searched the PubMed and EMBASE databases
for studies reporting disease progression or mortality
among HIV/HCV coinfected patients published through
April 2008; further studies were identified from cited
references. Cross-sectional studies, trials without
HCV negative control subjects, and studies involving
children or liver transplant recipients were excluded.
meta-analysis included 37 studies -- 10 from the pre-HAART
era (i.e., before 1996) and 20 from the HAART era --
with more than 100,000 total participants (about 14,600
pre-HAART and about 87,000 HAART era).
the pre-HAART era, the risk ratio for overall mortality
among HIV/HCV coinfected patients compared with
HIV monoinfected individuals was 0.68, indicating
a modestly lower risk of death.
the HAART era, the risk ratio for AIDS-defining
events was 1.12, or 12% higher, for coinfected compared
with HIV monoinfected patients --not a significant
HAART era risk ratio for overall mortality was 1.35,
indicating a 35% higher risk for coinfected individuals.
at the combined outcomes of AIDS diagnosis or death,
coinfected individuals had a risk ratio of 1.49,
or a 49% increased risk.
risk of death increased with longer duration of
coinfection did not increase mortality among patients
with HIV infection before the introduction of HAART,"
the study authors concluded. "In contrast, in the
HAART era, HCV coinfection, compared with HIV infection
alone, increases the risk of mortality, but not the
risk of AIDS-defining events."
their discussion, they suggested that while HIV positive
patients in the pre-HAART era typically did not survive
long enough to develop advanced HCV-related liver damage,
liver disease is likely the major contributor to mortality
among coinfected individuals since HAART has become
widely available. Numerous studies in the U.S. and Europe
have shown that liver disease is now a leading cause
of death for HIV positive people, especially coinfected
studies should determine whether successful treatment
of HCV infection could reduce this excess risk of mortality
in coinfected patients," the researchers recommended.
State University, Detroit Medical Center, Detroit, MI;
Departments of Nutrition and Epidemiology, Harvard School
of Public Health, Boston, MA; Division of Infectious
Diseases, Massachusetts General Hospital, Boston, MA.
T-Y Chen, EL Ding, GR Seage, and others. Meta-Analysis:
Increased Mortality Associated with Hepatitis C in HIV-Infected
Persons Is Unrelated to HIV Disease Progression. Clinical
Infectious Diseases 49(10): 1605-1615. November