Is Response to Anti-Hepatitis C Virus Treatment Predictive of Mortality in Hepatitis C virus/HIV-positive Patients?

AIDS. 2017 Mar 13;31(5):661-668. doi: 10.1097/QAD.0000000000001378.

Abstract

Background: Long-term clinical outcomes after hepatitis C virus (HCV) treatment of HIV/HCV patients are not well described. We aimed to compare the risk of all-cause and liver-related death (LRD) according to HCV treatment response in HIV/HCV patients in the multicohort study Collaboration of Observational HIV Epidemiological Research in Europe.

Methods: All patients who had started pegylated interferon + ribavirin (baseline) and followed for at least 72 weeks after baseline were included. Patients were categorized into three response groups depending on treatment duration and HCV-RNA measured in the window 24-72 weeks after baseline. Patients who received at least 24 weeks of therapy were defined as responders if their last HCV-RNA measured between 24 and 72 weeks after baseline was negative, and having 'unknown response' if HCV-RNA was unknown. Nonresponders were treated for less than 24 weeks or were HCV-RNA+ between 24 and 72 weeks after baseline. Mortality rates were compared using survival analysis, and Cox regression was used to compare hazard ratios of death between response groups.

Results: A total of 3755 patients were included: 1031 (27.5%) responders, 1639 (43.6%) nonresponders and 1085 (28.9%) with unknown response. Rates [per 1000 person-years of follow-up, 95% confidence interval (CI)] of all-cause death were 17.59 (14.88-20.78), 10.43 (7.62-14.28) and 11.00 (8.54-14.23) for nonresponders, responders and unknown responders, respectively. After adjustment, the relative hazard (nonresponders vs. responders) for all-cause death, LRD and nonliver-related death was 1.53 (95% CI 1.06-2.22), 3.39 (95% CI 1.32-8.75) and 1.22 (95% CI 0.80-1.84), respectively.

Conclusion: HIV/HCV patients with a favourable virological response to pegylated interferon + ribavirin had reduced risk of all-cause and LRD, whereas there was no difference in risk of nonliver-related death when comparing responders and nonresponders.

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • Cohort Studies
  • Coinfection / drug therapy
  • Coinfection / mortality*
  • Europe
  • Female
  • HIV Infections / complications*
  • Hepacivirus
  • Hepatitis C, Chronic / drug therapy
  • Hepatitis C, Chronic / mortality*
  • Humans
  • Interferon-alpha / therapeutic use
  • Male
  • Middle Aged
  • Mortality*
  • Prognosis
  • RNA, Viral / blood
  • Ribavirin / therapeutic use
  • Survival Analysis
  • Sustained Virologic Response*
  • Treatment Outcome
  • Viral Load

Substances

  • Antiviral Agents
  • Interferon-alpha
  • RNA, Viral
  • Ribavirin