TY - JOUR
T1 - Mortality in hepatitis C virus-infected patients with a diagnosis of AIDS in the era of combination antiretroviral therapy
AU - Branch, Andrea D.
AU - Van Natta, Mark L.
AU - Vachon, Marie Louise
AU - Dieterich, Douglas T.
AU - Meinert, Curtis L.
AU - Jabs, Douglas A.
N1 - Funding Information:
Financial support. This work was supported by the National Institutes of Health Eye Institute to the Mount Sinai School of Medicine (grant U10 EY 008052); the Johns Hopkins University Bloomberg School of Public Health (grant U10 EY08057); and the University of Wisconsin, Madison (grant U10 EY08067); and by the National Institute on Drug Abuse and the National Institute of Diabetes and Digestive and Kidney Diseases to the Mount Sinai School of Medicine (grants DA031095 and DK090317).
PY - 2012/7
Y1 - 2012/7
N2 - Background. Before the introduction of combination antiretroviral therapy (cART), patients infected with the human immunodeficiency virus (HIV) rarely died of liver disease. In resource-rich countries, cART dramatically increased longevity. As patients survived longer, hepatitis C virus (HCV) infection became a leading cause of death; however, because patients with AIDS continue to have 5-fold greater mortality than non-AIDS patients, it is unclear whether HCV infection increases mortality in them.Methods.In this investigation, which is part of the Longitudinal Studies of the Ocular Complications of AIDS, plasma banked at enrollment from 2025 patients with AIDS as defined by the Centers for Disease Control and Prevention were tested for HCV RNA and antibodies.Results. Three hundred thirty-seven patients had HCV RNA (chronic infection), 91 had HCV antibodies and no HCV RNA (cleared infection), and 1597 had no HCV markers. Median CD4+ T-cell counts/L were 200 (chronic), 193 (cleared), and 175 (no markers). There were 558 deaths. At a median follow-up of 6.1 years, patients with chronic HCV had a 50 increased risk of mortality compared with patients with no HCV markers (relative risk [RR], 1.5; 95 confidence interval [CI], 1.2-1.9; P =. 001) in an adjusted model that included known risk factors. Mortality was not increased in patients with cleared infection (RR, 0.9; 95 CI,. 6-1.5; P =. 82). In patients with chronic HCV, 20.4 of deaths were liver related compared with 3.8 in patients without HCV.Conclusions.Chronic HCV infection is independently associated with a 50 increase in mortality among patients with a diagnosis of AIDS, despite competing risks. Effective HCV treatment may benefit HIV/HCV-coinfected patients with AIDS.
AB - Background. Before the introduction of combination antiretroviral therapy (cART), patients infected with the human immunodeficiency virus (HIV) rarely died of liver disease. In resource-rich countries, cART dramatically increased longevity. As patients survived longer, hepatitis C virus (HCV) infection became a leading cause of death; however, because patients with AIDS continue to have 5-fold greater mortality than non-AIDS patients, it is unclear whether HCV infection increases mortality in them.Methods.In this investigation, which is part of the Longitudinal Studies of the Ocular Complications of AIDS, plasma banked at enrollment from 2025 patients with AIDS as defined by the Centers for Disease Control and Prevention were tested for HCV RNA and antibodies.Results. Three hundred thirty-seven patients had HCV RNA (chronic infection), 91 had HCV antibodies and no HCV RNA (cleared infection), and 1597 had no HCV markers. Median CD4+ T-cell counts/L were 200 (chronic), 193 (cleared), and 175 (no markers). There were 558 deaths. At a median follow-up of 6.1 years, patients with chronic HCV had a 50 increased risk of mortality compared with patients with no HCV markers (relative risk [RR], 1.5; 95 confidence interval [CI], 1.2-1.9; P =. 001) in an adjusted model that included known risk factors. Mortality was not increased in patients with cleared infection (RR, 0.9; 95 CI,. 6-1.5; P =. 82). In patients with chronic HCV, 20.4 of deaths were liver related compared with 3.8 in patients without HCV.Conclusions.Chronic HCV infection is independently associated with a 50 increase in mortality among patients with a diagnosis of AIDS, despite competing risks. Effective HCV treatment may benefit HIV/HCV-coinfected patients with AIDS.
UR - http://www.scopus.com/inward/record.url?scp=84862179941&partnerID=8YFLogxK
U2 - 10.1093/cid/cis404
DO - 10.1093/cid/cis404
M3 - Article
C2 - 22534149
AN - SCOPUS:84862179941
SN - 1058-4838
VL - 55
SP - 137
EP - 144
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -