Clinical

In HIV-HCV coinfection, HCV clearance reduces overall mortality

Last Updated: 2009-08-25 17:27:15 -0400 (Reuters Health)

By Scott Baltic

NEW YORK (Reuters Health) - In HIV-infected patients who also have chronic hepatitis C virus (HCV) infection, a sustained virological response to interferon and ribavirin reduces liver-related complications and overall mortality, according to findings by Spanish researchers.

Chronic HCV infection is "one of the most clinically relevant comorbid conditions in the HIV-infected population," and this study is the largest to date to assess the natural history of hepatitis C after interferon-ribavirin therapy in these patients, according to Dr. Juan Berenguer of the Hospital Gregorio Maranon, Madrid, and colleagues at 11 centers.

Sustained virological response was defined in this study as undetectable HCV RNA 24 weeks after the end of treatment.

In email correspondence with Reuters Health, Dr. Berenguer highlighted two findings in particular. First, the benefits of interferon-ribavirin therapy were seen in the relatively short average follow-up period of 20.8 months.

"Second," he said, "these benefits were independent of the presence of advanced fibrosis," whereas in patients with HCV alone, a sustained virological response reduces the risk of clinical events only in patients with advanced fibrosis or cirrhosis.

The researchers studied 711 patients with HIV and HCV who began therapy with interferon and ribavirin between January 2000 and December 2005. Their median age was 41 years, 72% were male, and the median time since HCV infection was 18 years. During the study period, 84% of the patients received highly active antiretroviral therapy.

The investigators report their findings in the August issue of Hepatology.

Overall, 218 patients (31%) achieved a sustained virological response. Independent predictors of sustained virological response were HCV genotype 2 or 3 (odds ratio 3.81), HCV RNA level below 500,000 IU/mL (OR 1.71), and nadir CD4-positive cell count (OR 1.01).

At a median follow-up of 18.7 months, responders had significantly lower rates than the group without a sustained virological response for liver-related deaths (0.5% versus 3.7%), deaths from any cause (0.9% versus 6.9%), and liver decompensation (0.5% versus 9.1%).

The authors point out that there was no reduction in the incidence of hepatocellular carcinoma, highlighting the need for continued surveillance, particularly in patients with advanced fibrosis and cirrhosis.

In addition, they warn that because their study was not prospective, its results could be biased.

Hepatology 2009;50:407-413.