Reuters Health Information (2004-11-30): Hepatitis C sequelae common among HIV-infected patients
Hepatitis C sequelae common among HIV-infected patients
Last Updated: 2004-11-30 14:33:03 -0400 (Reuters Health)
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
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
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.