Epidemiology

HCV infection tied to increased mortality in HIV+ patients during HAART era

Last Updated: 2009-11-27 9:00:32 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Since the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s, hepatitis C virus (HCV) infection has become an important contributor to mortality in HIV-infected patients, new research shows.

The results show that during the HAART era, HCV infection increases the risk of death, but not the risk of an AIDS-defining illness.

"Before the introduction of HAART, mortality related to HIV overwhelmed that related to HCV," Dr. Ting-Yi Chen, from Wayne State University in Detroit, and associates note. Since then, studies on the reciprocal effects of the two viruses on disease progression have yielded conflicting results.

Dr. Chen's team conducted a meta-analysis to estimate the effect of HCV infection on HIV disease progression and overall mortality in the pre-HAART (before 1996) and HAART eras. Their findings appear in the November 15th issue of Clinical Infectious Diseases.

Their analysis included 10 studies in the pre-HAART era with 4413 HCV-HIV coinfected patients and 10,213 HIV-monoinfected patients. The HAART era was represented by 27 studies involving 25,319 coinfected patients and 61,697 HIV-monoinfected patients.

The pre-HAART analysis implied that HCV had a protective effect (risk ratio for mortality, 0.69). However, once a single study that recruited patients through hospitalization was excluded, the remaining studies no longer showed a protective effect, either individually or in aggregate, the report indicates.

By contrast, dual infection was associated with increased mortality during the HAART era (RR 1.35). But there was no significant evidence of increased risk for AIDS-defining events in coinfected patients during this latter period.

"Potential mechanisms by which HCV infection may accelerate progression to AIDS (e.g., a blunted immunologic response to HAART) may not have significant clinical impact," the authors maintain.

Thus, it is likely that the major contributor to mortality in these patients is likely to be liver disease.

These findings imply that "broader application of more effective anti-HCV therapies is needed to reduce this excess mortality," Dr. Chen and associates write.

Clin Infect Dis 2009;49:1605-1615.