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Is response to anti–hepatitis C virus treatment predictive of mortality in hepatitis C virus/HIV-positive patients?

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Peters Lars, The Hepatitis C Working Group for the Collaboration of Observational HIV Epidemiological Research Eu,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal AIDS
Volume (Issue) 31(5)
Page(s) 661 - 668
Title of proceedings AIDS
DOI 10.1097/qad.0000000000001378

Open Access

URL http://doi.org/10.1097/QAD.0000000000001378
Type of Open Access Publisher (Gold Open Access)

Abstract

Background: Long-term clinical outcomes after hepatitis C virus (HCV) treatment of HIV/HCV patients are not well described. We aimed to compare the risk of all-cause and liver-related death (LRD) according to HCV treatment response in HIV/HCV patients in the multicohort study Collaboration of Observational HIV Epidemiological Research in Europe. Methods: All patients who had started pegylated interferon + ribavirin (baseline) and followed for at least 72 weeks after baseline were included. Patients were categorized into three response groups depending on treatment duration and HCV-RNA measured in the window 24–72 weeks after baseline. Patients who received at least 24 weeks of therapy were defined as responders if their last HCV-RNA measured between 24 and 72 weeks after baseline was negative, and having ‘unknown response’ if HCV-RNA was unknown. Nonresponders were treated for less than 24 weeks or were HCV-RNA+ between 24 and 72 weeks after baseline. Mortality rates were compared using survival analysis, and Cox regression was used to compare hazard ratios of death between response groups. Results: A total of 3755 patients were included: 1031 (27.5%) responders, 1639 (43.6%) nonresponders and 1085 (28.9%) with unknown response. Rates [per 1000 person-years of follow-up, 95% confidence interval (CI)] of all-cause death were 17.59 (14.88–20.78), 10.43 (7.62–14.28) and 11.00 (8.54–14.23) for nonresponders, responders and unknown responders, respectively. After adjustment, the relative hazard (nonresponders vs. responders) for all-cause death, LRD and nonliver-related death was 1.53 (95% CI 1.06–2.22), 3.39 (95% CI 1.32–8.75) and 1.22 (95% CI 0.80–1.84), respectively. Conclusion: HIV/HCV patients with a favourable virological response to pegylated interferon + ribavirin had reduced risk of all-cause and LRD, whereas there was no difference in risk of nonliver-related death when comparing responders and nonresponders.
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