Epidemiology

Hepatitis C sequelae common among HIV-infected patients

Last Updated: 2004-11-30 14:33:03 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Hepatitis C (HCV) infection increases the rate of nonalcoholic cirrhosis and hepatocellular carcinoma (HCC) in patients with HIV infection, according to a report in the November 22nd Archives of Internal Medicine.

"Basically, patients are living long enough now to develop complications of HCV infection," Dr. Thomas P. Giordano from Department of Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas told Reuters Health. "So screening for HCV in persons with HIV is important, and treatment for HCV should be considered."

Dr. Giordano and colleagues measured the incidence and relative risk of nonalcoholic cirrhosis and HCC after discharge in 16,349 HIV-infected patients with (4761) and without (11,678) HCV coinfection.

The incidence of cirrhosis was nearly 11 times higher among HCV-coinfected patients than among those without HCV coinfection, the authors report.

During the era of highly active antiretroviral therapy (HAART), HIV-infected patients with HCV coinfection were 22.48 times more likely than those without HCV coinfection to develop cirrhosis.

Similarly, the incidence of HCC was 6.5 times higher among HCV-coinfected patients than patients without HCV coinfection. In the HAART era, the results indicate, the incidence of HCC was 5.23 times higher among HCV-coinfected patients.

After adjustment for age, chronic hepatitis B, and other factors, HCV-coinfected patients still had a 19-fold higher incidence of cirrhosis and a 5-fold higher incidence of HCC than did patients without HCV coinfection, the researchers note.

"I should emphasize that the risk of cirrhosis and HCC, while increased in the HAART era, is likely partly due to the vastly improved survival seen with HAART," Dr. Giordano explained. "Rather than seeing these data as indicating a problem with HAART, they indicate a success of HAART."

Currently, antiviral treatment of HCV is recommended for persons with HIV who have "a CD4 count over 350 cells/microliter, chronic HCV infection, evidence of liver damage by biopsy or at least by laboratory evaluation, without evidence of decompensated cirrhosis, and no contraindications for anti-HCV treatment," Dr. Giordano said.

"Persons with advanced HIV should focus first on achieving HIV viral control and restoring their immune system, because their risk of complications from inadequately treated HIV far outweigh their risk of untreated HCV," Dr. Giordano concluded. "Initiating treatment for HCV and HIV at the same time should generally be avoided because of overlapping toxicities of the drugs."

Arch Intern Med 2004;164:2349-2354.