hepatitis C increases the risk of death for patients with AIDS by 50%,
according to the results of a large study published in the online edition of Clinical Infectious Diseases. A fifth of
these deaths were attributable to liver-related causes, five times the rate
seen in people with AIDS who were not co-infected.
The investigators also
found that a third of co-infected patients were unaware of their hepatitis C
“The negative impact
of liver disease on survival emphasises the need for patients with AIDS to be
aware of their HCV [hepatitis C virus] status so that they can fully
participate in their health care and risk reduction,” comment the authors.
“Heightened HCV awareness may increase the proportion of patients seeking
treatment and achieving a SVR [sustained virological response].”
Few deaths in HIV-positive people were attributable to liver disease in the period before effective
antiretroviral treatment became available. However, large numbers of
people with HIV are co-infected with hepatitis C virus and liver disease
caused by this infection is now an increasingly important cause of death among
these co-infected people.
A meta-analysis of studies has shown that coinfection increases the risk of death by around 35% in people with HIV and hepatitis C. Nevertheless, it remains unclear if hepatitis C
increases the risk of death for patients who have progressed to AIDS and who
continue to have an elevated risk of death due to HIV-related causes. 35,000 people were diagnosed with AIDS in 2009 in the United States alone, so this remains a pressing question even for developed countries, due to high rates of late diagnosis and poor access to care for marginalised populations.
To gain a clearer
understanding of this issue, a team of US investigators analysed mortality
records for 2026 AIDS patients who received care between 1998 and 2009.
Blood samples obtained
from the patients on entry to the study were tested for hepatitis C antibodies
and viral load
A total of 421
patients (21%) had evidence of past or current hepatitis C infection. This
included 91 patients (21%) who had apparently cleared the infection.
There were 558 deaths
during a median of 6.1 years of follow-up.
After adjusting for
other risk factors, the results showed that chronic hepatitis C co-infection
increased the risk of death by 50% (RR = 1.5; 95% CI, 1.2-1.9; p = 0.001).
Prior infection with hepatitis C did not increase the risk of death.
Of the 113 deaths in
people co-infected with chronic hepatitis C, some 20% were attributed to
liver-related causes. This compared to just 4% of deaths in people who did
not have hepatitis C.
“Patients with chronic
infection were more than five times more likely to die of liver-related causes
than patients with no markers of HCV (p < 0.0001),” note the authors.
Questioning of patients
revealed that almost third of individuals with chronic hepatitis C were unaware
of their infection.
“Research is needed to
determine whether the failure to accurately report positive HCV status
reflected failure of physicians to test for HCV, lack of communication,
miscommunication, or denial,” write the researchers.
The research may also
have implications for hepatitis C screening strategies. The results showed that
7% of patients with chronic infection would have been undiagnosed had they
relied on hepatitis B antibody tests.
underscore the urgency of efforts to screen AIDS patients for HCV and to make
sure that the test results and their implications are clearly communicated,”
conclude the investigators. “Broader screening and more patient education are
needed to maximize the benefits of new [HCV] treatments and to lower