Effect of HCV Infection on Cause-Specific Mortality After HIV Seroconversion, Before and After 1997
Por:
van der Helm, J, Geskus, R, Sabin, C, Meyer, L, del Amo, J, Chene, G, Dorrucci, M, Muga, R, Porter, K, Prins, M, Garcia-de-Olalla, P, CASCADE Collaboration EuroCoord
Publicada:
1 abr 2013
Resumen:
BACKGROUND & AIMS: Individuals with human immunodeficiency virus (HIV) infection frequently also are infected with hepatitis C virus (HCV) (co-infection), but little is known about its effects on the progression of HIV-associated disease. We aimed to determine the effects of co-infection on mortality from HIV and/or acquired immune deficiency syndrome (AIDS), and hepatitis or liver disease, adjusting for the duration of HIV infection. METHODS: We analyzed data from the 16 cohorts of the Concerted Action on Seroconversion to AIDS and Death in Europe (CASCADE) collaboration, which included information on HCV infection and cause of death. A competing-risks proportional subdistribution hazards model was used to evaluate the effect of HCV infection on the following causes of death: HIV- and/or AIDS-related, hepatitis- or liver-related, natural, and non-natural. RESULTS: Of 9164 individuals with HIV infection and a known date of seroconversion, 2015 (22.0%) also were infected with HCV. Of 718 deaths, 395 (55.0%) were caused by HIV infection and/or AIDS, and 39 (5.4%) were caused by hepatitis or liver-related disease. Among individuals infected with only HIV or with co-infection, the mortality from HIV infection and/or AIDS-related causes and hepatitis or liver disease decreased significantly after 1997, when combination antiretroviral therapy became widely available. However, after 1997, HIV and/or AIDS-related mortality was higher among co-infected individuals than those with only HIV infection in each risk group: injection drug use (adjusted hazard ratio [aHR], 2.43; 95% confidence interval [CI], 1.14-5.20), sex between men and women or hemophilia (aHR, 3.43; 95% CI, 1.70-6.93), and sex between men (aHR, 3.11; 95% CI, 1.49-6.48). Compared with individuals infected with only HIV, co-infected individuals had a higher risk of death from hepatitis or liver disease. CONCLUSIONS: Based on analysis of data from the CASCADE collaboration, since 1997, when combination antiretroviral therapy became widely available, individuals co-infected with HIV and HCV have had a higher risk of death from HIV and/or AIDS, and from hepatitis or liver disease, than patients infected with only HIV. It is necessary to evaluate the effects of HCV therapy on HIV progression.
Filiaciones:
van der Helm, J:
Publ Hlth Serv Amsterdam, NL-1018 WT Amsterdam, Netherlands
Geskus, R:
Publ Hlth Serv Amsterdam, NL-1018 WT Amsterdam, Netherlands
Univ Amsterdam, Acad Med Ctr, Dept Clin Epidemiol Biostat & Bioinformat, NL-1105 AZ Amsterdam, Netherlands
Sabin, C:
UCL, Res Dept Infect & Populat Hlth, London, England
Meyer, L:
Hop Bicetre, AP HP, Serv Epidemiol & Sante Publ, Paris, France
INSERM, U1018, Paris, France
Univ Paris Sud, Paris, France
del Amo, J:
Inst Salud Carlos III, Madrid, Spain
Chene, G:
Univ Bordeaux Segalen, Bordeaux, France
INSERM, U897, Bordeaux, France
CHU, Ctr Invest Clin Epidemiol Clin CIC EC7, Bordeaux, France
Dorrucci, M:
Ist Super Sanita, I-00161 Rome, Italy
Muga, R:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Badalona, Spain
Porter, K:
MRC, Clin Trials Unit, London, England
Prins, M:
Publ Hlth Serv Amsterdam, NL-1018 WT Amsterdam, Netherlands
Univ Amsterdam, Acad Med Ctr, Ctr Infect & Immun Amsterdam CINIMA, NL-1105 AZ Amsterdam, Netherlands
Garcia-de-Olalla, P:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
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