Coinfection With HCV Worsens the Condition of HIV Patients Receiving Antiretrovirals

Research led by Vincent Lo Re III, MD, MSCE, at the Perelman School of Medicine, University of Pennsylvania, identified an increased risk of liver decompensation (extensive liver damage, such that the liver can no longer function normally1) among patients coinfected with the hepatitis C virus (HCV) and human immunodeficiency virus (HIV) and receiving antiretroviral therapy (ART). The control population for the study was HCV-monoinfected patients.2 Although ART is known to slow hepatitis C-associated liver fibrosis, liver complications in HCV- and HIV-coinfected patients treated with ART were unknown.3

The study, published in the Annals of Internal Medicine, was conducted in 4280 coinfected patients who initiated ART and 6079 HCV-monoinfected patients, treated between 1997 to 2010. All the patients were HCV-treatment naïve, although with detectable HCV RNA. The study found that hepatic decompensation was greater in patients coinfected with the 2 viruses (7.4% at 10 years) compared with the monoinfected patients (4.8% at 10 years). Further, compared with the monoinfected patients, the coinfected patients had a higher rate of hepatic decompensation than the monoinfected patients (hazard ratio [HR] for competing risks, 1.56 [95% confidence interval (CI), 1.31-1.86]). Coinfected patients with HIV RNA load less than 1000 copies/mL still had higher decompensation than HCV-monoinfected patients (HR, 1.44 [CI,1.05-1.99]).

Baseline advanced hepatic fibrosis (FIB-4 score, 3.25) (HR, 5.45 [CI, 3.79-7.84]), baseline hemoglobin less than 100 g/L (HR, 2.24 [CI, 1.20-4.2]), diabetes mellitus (HR, 1.88 [CI, 1.38-2.56]), and nonblack race (HR, 2.12 [CI, 1.65-2.72]) were also associated with higher rates of decompensation among coinfected patients.2 According to Lo Re, “Our results suggest that serious consideration should be given to initiating hepatitis C treatment in patients coinfected with HIV and hepatitis C—particularly among those with advanced liver fibrosis or cirrhosis—in order to try to reduce the risk of serious, potentially life-threatening liver complications. By taking action sooner, we may be able to reduce the risk of advanced liver disease in coinfected patients.”3

Hepatitis C is an infectious disease of the liver that is thought to affect 180 million persons worldwide, 4 million of whom are in the United States. Disease symptoms include dark urine, fatigue, jaundice, loss of appetite, abdominal pain, and nausea or vomiting. Only 15% to 25% of those infected with HCV are expected to completely recover. With damage to the liver, 55% to 85% of the infected population is estimated to develop chronic infection, and 75% of those with a chronic infection will develop chronic liver disease.4