Focus on mortality in HIV/HCV co-infection under DAAs

HIV coinfection is quite common in HCV patients. However, little research has been done on the influence of such co-infections on the morbidity and mortality of those affected.

HIV co-infection increases non-liver-associated mortality in HCV

HIV coinfection is quite common in HCV patients. However, little research has been done on the influence of such co-infections on the morbidity and mortality of those affected.

In general, HIV coinfection in Hepatitis-C Virus (HCV) patients has always been considered to lead to a shorter sustained virological response (SVR), faster liver fibrosis, and a higher risk of liver-associated and non-liver-associated events. Nevertheless, thanks to new, highly effective antiretroviral drugs (direct-acting antiviral drugs or DAA), HCV-mediated complications have recently decreased significantly. 

Under DAAs, more than 90% of patients achieve a long-lasting SVR and this applies both to HCV-monoinfected patients and those with an HIV/HCV coinfection. Although it has also been shown in practice that a prolonged virological response has a positive effect on the course of the disease, very little is known about the effects of HIV co-infection after DAA treatment.

First study on the influence of HIV/HCV coinfections

A total of 592 people with HIV/HCV co-infection and 2,049 people with HCV monoinfected took part in the study. The median age of the patients was 52.9 years and 53.3 years, respectively. Nearly three-quarters of those affected were men (73%). The majority of patients were treated with sofosbuvir + ledipasvir or sofosbuvir + daclatasvir. A long-term virological response occurred in more than 90% of patients.

After about 3 years of follow-up, there was no difference in liver-associated events and liver-associated mortality between patients with HCV mono-infection or HIV/HCV coinfection, but non-liver-associated mortality was significantly higher in HIV/HCV coinfected patients compared to mono-infection (12.5 per 1000 person-years vs. 4.9 per 1000 person-years).

What does this mean in practice?

HIV co-infection is not associated with a higher risk of liver-associated events (HR = 0.67; 95% CI: 0.27-1.67) or liver-associated mortality (HR = 0.94; 95% CI: 0.19-4.67) in the presence of HCV. However, coinfection does influence the non-liver-associated mortality of the patients concerned (HR = 2.67; 95%-ID: 0.97-7.37).

Chalouni M et al., AS153: "HIV co-infection and risk of morbidity and mortality in HCV-patients treated by DAA", ILC 2020 (digital)

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