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Liver-related death among HIV/hepatitis C virus-co-infected individuals: implications for the era of directly acting antivirals.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Grint Daniel, Peters Lars, Rockstroh Juergen K, Rakmanova Aza, Trofimova Tatiana, Lacombe Karine, Karpov Igor, Galli Massimo, Domingo Pere, Kirk Ole, Lundgren Jens D, Mocroft Amanda, EuroSIDA in EuroCoord,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal AIDS (London, England)
Volume (Issue) 29(10)
Page(s) 1205 - 15
Title of proceedings AIDS (London, England)
DOI 10.1097/qad.0000000000000674

Open Access

URL http://doi.org/10.1097/QAD.0000000000000674
Type of Open Access Publisher (Gold Open Access)

Abstract

Potent, less toxic, directly acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) infection promise to improve HCV cure rates among HIV/HCV-co-infected individuals. However, the costs of treatment will necessitate prioritization of those at greatest risk of liver-related death (LRD) for therapy. This study aims to provide guidance on who should be prioritized for DAA treatment. Three thousand, nine hundred and forty-one HCV antibody-positive PSHREG and FIB-4 are names not acronyms (EuroSIDA) patients with follow-up after 1 January 2000 were included, with causes of death classified using Coding causes of Death in HIV (CoDe) methodology. Crude death rates, competing-risks Cox proportional-hazards models and cumulative incidence functions were used to describe factors associated with LRD. LRD accounted for 145 of 670 (21.6%) deaths in the study population. LRD rates peaked in those aged 35-45 years, and occurred almost exclusively in those with at least F2 fibrosis at baseline. In adjusted Cox models, risk factors for LRD included F4 or F2/F3 fibrosis [sub-distribution hazard ratio (sHR) 6.3, 95% confidence interval (CI) 4.1-9.6; and sHR 2.5, 95% CI 1.5-4.2 vs. F0/F1, respectively), CD4 cell count (sHR 0.83, 95% CI 0.73-0.95 per doubling) and hepatitis B surface antigen-positive (sHR 2.2, 95% CI 1.3-3.5 vs. hepatitis B surface antigen-negative). The 5-year probability of LRD was low in those with F0/F1 fibrosis (sHR 2.2%, 95% CI 1.7-2.9), but substantial in those with F2/F3 and F4 fibrosis (sHR 10.3%, 95% CI 7.6-13.5; and sHR 14.0%, 95% CI 10.3-18.3, respectively). Treatment with DAAs should be prioritized for those with at least F2 fibrosis. Early initiation of cART with the aim of avoiding low CD4 cell counts should be considered essential to decrease the risk of LRD and the need for HCV treatment.
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