antiretroviral therapy (ART) significantly reduces the risk of serious liver
disease for people with HIV and hepatitis C virus (HCV) co-infection, results
of a large US study published in the online edition of Clinical Infectious Diseases show.
therapy reduced the risk of decompensated liver disease by between 28 and 41%.
support current US treatment guidelines that recommend antiretroviral therapy for
all patients with HIV and hepatitis C co-infection.
“Our results favor
treatment of HIV in patients coinfected with HCV,” write the authors, who assert
their findings “provide direct evidence to support recent clinical guidelines
recommending consideration of ART initiation in HIV/HCV coinfected individuals,
regardless of CD4 cell count.”
Between a quarter
and a third of people living with HIV in the US have hepatitis C co-infection. HIV
can accelerate hepatitis C disease progression and liver disease is now a leading cause
of death in people with this co-infection.
The benefits of
starting antiretroviral therapy in terms of hepatitis C disease progression are
unclear. Some cross-sectional studies have suggested that HIV treatment can
slow the course of hepatitis C disease, but there are also concerns in some quarters
that antiretroviral therapy could lead to immune reconstitution illness,
increasing the risk of decompensated liver disease.
To further elucidate
the benefits or HIV treatment for people with HIV and hepatitis C, investigators from the Veterans
Aging Cohort Study Virtual Cohort (VACS VC) designed a longitudinal study
involving approximately 10,000 people with HIV and hepatitis C co-infection. All received care between 1996 and the present
day and were antiretroviral naive when they entered the cohort.
The risk of
hepatic decompensation (hospital admission with this diagnosis or the presence
of two or more outpatient diagnoses for ascites, spontaneous bacterial
peritonitis or oesophageal variceal haemorrhage) was compared between people
who started HIV therapy and those who remained treatment naive.
All the study participants
were men and none were documented as having received HIV therapy at baseline.
A little under two-thirds (61%) were black and the median age on entry to the
cohort was 47 years. Chronic hepatitis B infection was present in 8% of
individuals. Over a third (36%) of patients had a baseline CD4 cell count below
200 cells/mm3 and 82% had a detectable baseline viral load.
The participants were
followed for a median of 3.1 years and contributed 46,444 person years of
follow-up. During this time, 36% of individuals initiated interferon-based hepatitis C
treatment. A total of 6935 people (69%) started HIV therapy over the course
of the study.
decompensation was recorded in 645 individuals (6%), an incidence rate of 1.4
per 100 person-years.
HIV therapy reduced the risk of hepatic decompensation by 28% (HR = 0.72; 95%
excluded the 1876 individuals who had a viral load below 400 copies/ml at baseline
despite no documented HIV therapy. Analysis of this population showed that
initiating ART reduced the risk of decompensated liver disease by 41% (HR =
0.59; 95% CI, 0.43-0.82).
demonstrated an average 28-41% reduction in the rate of hepatic decompensation
for ART initiators relative to non-initiators in our study population of
HIV/HCV-coinfected male veterans,” conclude the authors. “Taken together with
the body of available literature, our results suggest a significant benefit of
ART for coinfected patients, and serve to inform therapeutic strategies as
caregivers face the continuing challenges of chronic hepatitis in HIV-infected