HCV/HIV-co-infected IDUs are at increased risk of death from hepatitis-related death in the HAART era, compared with HCV-mono-IDUs
Maria Prins and coworkers from the Amsterdam Cohort Studies compared mortality from specific causes of death in HCV/HIV-co-infected IDUs with that of HCV-mono-infected IDUs and IDU swithout HCV and HIV, before and after the widespread use of HAART.
The study population consisted of 1276 IDUs from the cohort that started in 1985. Blood samples collected for HIV testing at 4- to 6-monthly visits was retrospectively tested for HCV.
The investigators found serological groups at study entry were: 19% HCV+/HIV+, 43% HCV+/HIV, 1% HCV/HIV+, 36% HCV/HIV. During follow-up, 272 IDU died. Overall, mortality risk decreased for most causes of death in the HAART era (defined as after 1997), but the risk was not the same across the groups. For the HIV+/HCV+ IDU group, the risk of death from AIDS decreased significantly (CHR 0.37, 95%CI 0.19 to 0.72), whereas the risk of hepatitis or liver-related death did not change over time (CHR 0.87, 95%CI 0.21 to 3.58). In the HCV+/HIV and HCV/HIV IDU groups, no significant changes in the risks of death were observed.
When comparing the risks of death among serologic groups, they found in the HAART era that the HCV+/HIV+ IDU group had a significantly higher risk of hepatitis or liver-related death than the HCV+/HIV IDU group (CHR 7.15, 95%CI 1.98 to 25.8). Increased risks of dying from non-natural and natural causes of death were also found. No major differences were observed between the HCV/HIV and HCV+/HIV IDU groups.
The investigators concluded that the risk of dying from HCV-related causes among HCV/HIV-co-infected IDU, has not increased after the introduction of HAART. But they found that compared to the HCV+/HIV IDU group, HCV/HIV-co-infected IDU remained at increased risk of hepatitis and liver-related death after1997, suggesting that HIV co-infection continues to accelerate HCV disease progression. They wrote: Efforts should be made to establish effective HCV treatment in HCV/HIV-co-infected persons.
Prins M, Smit C, van den Berg C et al. HCV/HIV-co-infected drug users are at increased risk of dying from hepatitis-related death in the HAART era, compared with HCV-mono-infected drug users. 14th CROI, 2007, Los Angeles. Poster Abstract 923.