Patients with both HIV and HCV have higher hepatic decompensation rates, despite antiretrovirals



Patients with HCV-HIV coinfections had significantly higher rates of hepatic decompensation vs. HCV-monoinfected patients, even when they received antiretroviral therapy and maintained low HIV RNA levels, researchers reported online March 17.

Decompensation rates in coinfected patients were significantly higher with concurrent advanced liver fibrosis, diabetes, or severe anemia or if patients were of nonblack race, reported Dr. Vincent Lo Re III of the University of Pennsylvania, Philadelphia, and his associates (Ann. Int. Med. 2014 Mar. 17 [doi:10.7326/M13-1829]).

Dr. Vincent Lo Re

The researchers conducted a retrospective cohort study of 4,280 Veterans Health Administration patients coinfected with HCV and HIV who initiated antiretroviral therapy (ART) and 6,079 HCV-monoinfected patients. Patients were treated between 1997 and 2010 and were HCV treatment naive.

The incidence of hepatic decompensation was 7.4% among coinfected patients and 4.8% among monoinfected patients at 10 years, the investigators reported. The difference was statistically significant (hazard ratio accounting for competing risks, 1.56; 95% confidence internal, 1.31-1.86), even when coinfected patients maintained HIV RNA levels of less than 1,000 copies/mL (HR, 1.44; 95% CI, 1.05-1.99).

The finding suggested that "suppression of HIV RNA with ART is an important factor in slowing progression of HCV-related liver fibrosis," the researchers wrote. "This observation supports current management guidelines that recommend initiation of ART among patients co-infected with HIV and HCV, regardless of CD4 cell count."

Hepatic decompensation in coinfected patients also was significantly associated with baseline advanced hepatic fibrosis, severe anemia (baseline hemoglobin level less than 100 g/L), diabetes mellitus, or being of nonblack race, with hazard ratios ranging between 1.88 and 5.45. "Clinicians should address modifiable risk factors and consider treatment of HCV infection in co-infected patients to reduce rates of hepatic decompensation," Dr. Lo Re and his colleagues wrote.

The study was supported by the National Institutes of Health. Investigator disclosures were not available.

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