Clinical

Hepatitis C virus coinfection ups risk of HIV-related infections

Last Updated: 2009-08-14 11:49:50 -0400 (Reuters Health)

NEW YORK (Reuters Health) - HIV-infected patients coinfected with hepatitis C virus (HCV) are over three times more likely to develop an HIV-related bacterial or mycotic infection compared with their HCV-negative counterparts, new research shows.

By contrast, HCV coinfection does not increase the risk of non-Hodgkin lymphoma, according to the report in the August 15th issue of Clinical Infectious Diseases.

"At present, with the exception of lymphoma, there are few data concerning the risk of specific opportunistic diseases in HCV-infected and -uninfected patients," Dr. Antonella d'Arminio Monforte, from San Paolo University Hospital Milan, Italy, and colleagues note.

In the present study, the researchers assessed the impact of chronic HCV infection and HCV-related cirrhosis on the development of AIDS-defining illnesses in a large cohort of HIV-infected patients from Italy. The study featured 5397 patients who were categorized into three groups: no HCV, HCV with cirrhosis, and HCV without cirrhosis.

During 25,105 person-years of follow-up, 496 AIDS-defining illnesses occurred. Mycotic infections, principally Pneumocystis jiroveccii pneumonia, and bacterial infections, primarily Mycobacterium tuberculosis infection, were the most common AIDS-defining illnesses, accounting for 154 and 133 of cases, respectively.

Rates were low, the authors note; for example mycotic and bacterial infections had a rate of 5-6 per 1,000 person-years of follow-up.

HCV coinfection increased the odds of developing an AIDS-defining illness by 2.61-fold, the report indicates. More specifically, HCV coinfection was linked to 3.87-, 3.15-, and 2.68-fold increased risks of mycotic disease, bacterial infection, and HIV-related disease (wasting syndrome and AIDS dementia complex), respectively.

Overall, coinfection was associated with a twofold increased risk of developing AIDS than were HIV-monoinfected patients. Their data also indicated that the increased risk of AIDS-related illnesses was not affected by use of antiretroviral therapy.

By contrast, HCV coinfection was not associated with elevated risks of non-Hodgkin lymphoma, viral infection, or protozoal infection.

Among HCV-infected patients, those with cirrhosis were at greater risk for mycotic infection, bacterial infection, toxoplasmosis, and HIV-related disease than were those without cirrhosis.

"Clinicians should take these data into account in their clinical management of HCV-coinfected patients, in particular when deciding when to start antiretroviral therapy," the authors advise.

The current study "provides important findings that may affect the clinical management of HCV-HIV coinfection," Dr. Lionel Piroth, from Centre Hospitalier Universitaire de Dijon, France, comments in a related editorial.

"It highlights and strengthens the need for careful follow-up of HCV-HIV-coinfected patients," he added, "including preventive measures (screening, prophylaxis, and vaccination for preventable diseases), effective management of associated comorbidities (particularly addictions), and early and effective therapies against HIV and HCV."

Clin Infect Dis 2009;49:612-625.