Washington, DC—Even when they are receiving anti-HIV drugs, people who are infected with both HIV and hepatitis C virus (HCV) are more likely than people who are infected only with HCV to experience a severe worsening of HCV-related liver disease and death, according to research reported here at the International AIDS Conference.
About one-quarter of individuals who are infected with HIV also have HCV infection. According to the US Centers for Disease Control and Prevention, HIV coinfection more than triples the risk for liver disease, liver failure, and liver-related death from HCV.
Although antiretroviral therapy (ART) slows the progression of HCV liver scarring, few studies have examined whether complications such as hepatic decompensation (a severe worsening of liver disease) differ among ART-treated patients who are coinfected with HIV compared with patients infected only with HCV. To investigate this question, Vincent Lo Re, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues conducted a retrospective cohort study comparing outcomes of 4280 ART-treated patients who were infected with both viruses vs those of 6079 patients infected only with HCV.
All patients were participants during the study period (1997-2010) in the Veterans Aging Cohort Study Virtual Cohort, most of them men and about two-thirds of them black, matched for age and race/ethnicity. After a 12-month baseline period, patients were followed up for as long as 12 months.
The researchers found that the risk of hepatic decompensation was significantly higher among HIV/HCV-coinfected patients than among those infected with HCV alone (6.3% vs 5.0%, respectively); the risk was nearly twice as high after the researchers adjusted for such factors as age, race, and history of alcohol abuse. The coinfected patients were also more like to die after decompensation.
Although the reason that HIV/HCV-coinfected patients fared less well than those with HCV infection alone despite receiving ART is unclear, higher immune activation, fatty liver, and apoptosis (programmed cell death) are possible factors, said Lo Re.
In the same session, Daniel Fierer, MD, of Mount Sinai School of Medicine in New York City, described several cases involving HIV-infected individuals who developed rapidly progressing liver scarring after infection with HCV. In patients who are not infected with HIV, such complications generally develop over the course of 20 to 30 years.
There’s a worldwide epidemic of acute HCV among HIV-infected men who have sex with men, noted Fierer. That situation underscores the importance of screening for HCV in this population, especially in light of the emergence of improved options for treating HCV.