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).

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

Esanum is an online network for approved doctors

Esanum is the medical platform on the Internet. Here, doctors have the opportunity to get in touch with a multitude of colleagues and to share interdisciplinary experiences. Discussions include both cases and observations from practice, as well as news and developments from everyday medical practice.

Esanum ist ein Online-Netzwerk für approbierte Ärzte

Esanum ist die Ärzteplattform im Internet. Hier haben Ärzte die Möglichkeit, mit einer Vielzahl von Kollegen in Kontakt zu treten und interdisziplinär Erfahrungen auszutauschen. Diskussionen umfassen sowohl Fälle und Beobachtungen aus der Praxis, als auch Neuigkeiten und Entwicklungen aus dem medizinischen Alltag.

Esanum est un réseau en ligne pour les médecins agréés

Esanum est un réseau social pour les médecins. Rejoignez la communauté et partagez votre expérience avec vos confrères. Actualités santé, comptes-rendus d'études scientifiques et congrès médicaux : retrouvez toute l'actualité de votre spécialité médicale sur esanum.