Conference reports, Hepatitis coinfection
Risk of developing specific AIDS-defining illnesses in patients coinfected with HIV and HCV with or without liver cirrhosis
Svilen Konov, HIV i-Base
An Italian study from the Sao Paolo Hospital in Milan looked into the correlation between the occurrence of different AIDS-defining illnesses (ADIs) and chronic HCV infection or HCV-related liver cirrhosis. [1]
There are few data concerning the risk of specific opportunistic diseases in patients with and without hepatitis C virus (HCV) infection.
The study was conducted in an Italian cohort of over 5000 HIV-positive patients, stratified into two groups: i) patients without HCV coinfection and with persistently normal aminotransferase levels and ii) patients with HCV coinfection. Coinfected patients were stratified according to liver cirrhosis. The incidence of new ADIs was calculated per 1000 person-years of follow-up by Poisson regression model and adjusted tor potential confounders.
The researchers observed 496 ADIs among 5397 patients over 25,105 person-years of follow-up, half of which were in coinfected patients. HCV coinfection was associated with an increased risk of developing an ADI (adjusted relative rate [ARR], 2.61; 95% confidence interval [CI], 1.88-3.61). Specific rates included, bacterial infection (ARR 3.15; 95%CI 1.76-5.67), HIV-related disease (ARR 2.68; 95%CI 1.03-6.97) and mycotic disease (ARR 3.87; 95%CI, 2.28-6.59), but not non-Hodgkin lymphoma (ARR, 0.88; 95% CI, 0.22-3.48).
HIV-monoinfected patients had a significantly lower rate of mycotic infection, bacterial infection, toxoplasmosis, and HIV-related ADI than among patients with HCV and cirrhosis. The risk among coinfected patients with cirrhosis was also greater than non-cirrhotic patients.
The researchers concluded that ‘HIV-related bacterial and mycotic infections are strongly associated with positive HCV serostatus and HCV-related cirrhosis’.
They strongly recommended that these data should be considered when deciding when to start antiretroviral therapy in HCV-coinfected individuals.
References:
D’Arminio Monforte et al. Risk of developing specific AIDS-defining illnesses in patients coinfected with HIV and hepatitis C virus with or without liver cirrhosis. Clin Infect Dis. 2009 Aug 15;49(4):612-22.
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