Clinical

Hepatitis C worsens outcome in HIV patients

Last Updated: 2006-06-01 12:39:00 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Coinfection with hepatitis C virus (HCV) has a deleterious effect on outcome in HIV patients receiving highly active antiretroviral therapy (HAART), according to Danish researchers. Nevertheless, factors other than the infection appear to be involved.

As senior investigator Dr. Niels Obel told Reuters Health "We found that HIV patients co-infected with hepatitis C have higher mortality. However, we presume that psycho-social factors -- for example, intravenous drug abuse -- are responsible for a major part of the excess risk of death."

Dr. Obel of Odense University Hospital and colleagues conducted a prospective cohort study of all adult Danish HIV patients who began HAART over a 10-year period beginning in 1995.

Of these, 2183 (80%) were HCV-negative, 443 (16%) were HCV- positive and the remaining 108 (4%) were untested, the team reports in the May 15th issue of Clinical Infectious Diseases.

Compared to the HCV-negative group, mortality was significantly higher in the positive group (rate ratio, 2.4). This was especially true of liver disease-related mortality (rate ratio, 16.0).

Overall, say the investigators, coinfected patients "had a weaker response to HAART in terms of viral load suppression and improvement in CD4+ cell counts."

This may not simply be due to HCV, the researchers suggest. Given the apparent role of lower compliance and greater alcohol and drug abuse in HCV-HIV coinfected patients, "increased attention to these factors is required to improve the prognosis."

Clin Infect Dis 2006;42:1481-1487.