Clinical outcomes in persons coinfected with HIV and HCV: Impact of HCV treatment

Abstract

Abstract Background Hepatitis C (HCV) cure is associated with changes in lipids and inflammatory biomarkers but its impact on clinical endpoints among treated HIV/HCV coinfected persons is unclear. Methods HIV-positive persons from EuroSIDA with known HCV status after January 2001 were classified into strata based on time-updated HCV-RNA measurements and HCV treatment: HCV antibody negative, spontaneously resolved HCV, chronic untreated HCV, cured HCV (HCV-RNA-negative), HCV treatment failures (HCV-RNA-positive). Poisson regression compared incidence rates between HCV groups for end-stage liver disease (ESLD; including hepatocellular carcinoma [HCC]), non-AIDS defining malignancy (NADM; excluding HCC) and cardiovascular disease (CVD). Results 16618 persons were included (median follow-up 8.3 (interquartile range 3.1–13.7) years). There were 887 CVD, 902 NADM and 436 ESLD events; crude incidence rates/1000 person-years follow-up (95% confidence interval [CI]) were 6.4 (6.0–6.9) CVD, 6.5 (6.1–6.9) NADM and 3.1 (2.8–3.4) ESLD. After adjustment, there were no differences in incidence rates of NADM or CVD across the five groups. HCV-negative individuals (adjusted incidence rate ratio [aIRR] 0.22 95% CI 0.14–0.34) and those with spontaneous clearance (aIRR 0.61; 95% CI 0.36–1.02) had reduced rates of ESLD compared to cured individuals. Persons with chronic untreated HCV infection (aIRR 1.47; 95% CI 1.02–2.13) or treatment failure (aIRR 1.80; 95% CI 1.22–2.66) had significantly raised rates of ESLD compared to those cured. Conclusions Incidence of NADM or CVD was independent of HCV group whereas those cured had a substantially lower incidence of ESLD, underlining the importance of successful HCV treatment for reducing ESLD.