Impact of Hepatitis C cure on risk of mortality and morbidity in people with HIV after ART initiation.

Chalouni, Mathieu; Trickey, Adam; Ingle, Suzanne M; Sepuvelda, Maria Antonia; Gonzalez, Juan; Rauch, Andri; Crane, Heidi M; Gill, M John; Rebeiro, Peter F; Rockstroh, Jürgen K; Franco, Ricardo A; Touloumi, Giota; Neau, Didier; Laguno, Montserrat; Rappold, Michaela; Smit, Colette; Sterne, Jonathan Ac; Wittkop, Linda (2023). Impact of Hepatitis C cure on risk of mortality and morbidity in people with HIV after ART initiation. AIDS, 37(10), pp. 1573-1581. Wolters Kluwer Health 10.1097/QAD.0000000000003594

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OBJECTIVE

Hepatitis C Virus (HCV) co-infection is associated with increased morbidity and mortality in people with HIV (PWH). Sustained virological response (SVR) decreases the risk of HCV-associated morbidity. We compared mortality, risk of AIDS-defining events, and non-AIDS non-liver (NANL) cancers between HCV co-infected PWH who reached SVR and mono-infected PWH.

DESIGN

Adult PWH from 21 cohorts in Europe and North America that collected HCV treatment data were eligible if they were HCV-free at time of ART initiation.

METHODS

Up to 10 mono-infected PWH were matched (on age, sex, date of ART start, HIV acquisition route, and being followed at the time of SVR) to each HCV co-infected PWH who reached SVR. Cox models were used to estimate relative hazards (HR) of all-cause mortality, AIDS-defining events, and NANL cancers after adjustment.

RESULTS

Among 62,495 PWH, 2,756 acquired HCV, of whom 649 reached SVR. For 582 of these, ≥1 mono-infected PWH could be matched, producing a total of 5,062 mono-infected PWH. The estimated HRs comparing HCV co-infected PWH who reached SVR with mono-infected PWH were 0.29 [95%CI 0.12-0.73] for mortality, 0.85 [0.42-1.74] for AIDS-defining events, and 1.21 [0.86-1.72] for NANL cancer.

CONCLUSION

PWH who reached SVR a short time after HCV acquisition were not at higher risk of overall mortality compared to mono-infected PWH. However, the apparent higher risk of NANL cancers in HCV co-infected PWH who reached SVR after a DAA-based treatment compared to mono-infected PWH, though compatible with a null association, suggests a need for monitoring of those events following SVR.

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6 Citations in Scopus

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