Does hepatitis C viremia or genotype predict the risk of mortality in individuals co-infected with HIV?

Abstract

Background & aims: The influence of HCV-RNA levels and genotype on HCV disease progression is not well studied. The prognostic value of these markers was investigated in HIV/HCV co-infected individuals from the EuroSIDA cohort.

Methods: EuroSIDA is a prospective cohort of 18,295 HIV-1 infected patients in 105 centres across Europe, Israel, and Argentina. All subjects with known HCV antibody (HCVAb) status (n=13,025) were enrolled in the present study.

Results: 4044 (31.0%) patients had detectable HCVAb. After adjustment, HCVAb+ patients had an increased incidence of liver-related death (LRD) compared to HCVAb- individuals (IRR 8.90; 95% CI 5.60-14.14, p<0.0001). Information on HCV-RNA was available for 2709 (67.0%) HCVAb+ patients and 2010 (74.2%) were HCV-RNA+. Of 1907 patients with measured HCV genotype, 1008 (52.9%), 62 (3.3%), 567 (29.7%), and 270 (14.2%) were infected with genotype 1, 2, 3 and 4, respectively. Patients with detectable HCV-RNA had similar incidence of non-LRD, but higher incidence of LRD compared to HCVAb+ aviremic patients (adjusted IRR 1.18; 95% CI 0.93-1.50, p=0.17) and (adjusted IRR 2.11; 95% CI 1.30-3.42, p=0.0025), respectively. In patients with HCV viremia, HCV-RNA levels and HCV genotype did not influence the risk of non-LRD or LRD.

Conclusions: HCV seropositive HIV patients had a 9-fold increased risk of LRD compared to patients who were HCV seronegative. Risk of death from any cause or LRD was not influenced by level of HCV viremia or HCV genotype.

Keywords: AIDS; ALT; Bac. Infect; CI; CVD; Co-infection; Genotype; HAART; HBV; HBsAg; HCV; HCVAb; HIV; Hepatitis C virus; IDU; IQR; IRR; IU/ml; LRD; Mortality; PYFU; RH; Viral load; acquired immune deficiency syndrome; alanine aminotransferase; anti-HCV antibody; bacterial infection; cART; cardiovascular disease; combination antiretroviral therapy; confidence interval; hepatitis B virus; hepatitis B virus surface antigen; hepatitis C virus; highly active antiretroviral therapy; human immunodeficiency virus; incidence rate ratio; injection drug use; international units/millilitre; interquartile range; liver-related death; person-years of follow-up; relative hazard.