The Effects of Hepatitis C Infection and Treatment on All-cause Mortality Among People Living With Human Immunodeficiency Virus

Alexander Breskin, Daniel Westreich, Stephen R. Cole, Michael G. Hudgens, Christopher B. Hurt, Eric Carl Seaberg, Chloe L Thio, Phyllis C. Tien, Adaora A. Adimora

Research output: Contribution to journalArticle

Abstract

Background Persons living with human immunodeficiency virus (HIV; PLwH) are commonly co-infected with hepatitis C virus (HCV). Most co-infected individuals can achieve a sustained HCV virologic response after treatment with direct-acting antivirals (DAA). However, the effect of HCV co-infection and DAA treatment on mortality after initiating antiretroviral therapy (ART) is unknown for PLwH. Methods We analyzed data from the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study. Participants included those who had prevalent HIV or seroconverted during follow-up; all were antiretroviral-naive and acquired immunodeficiency syndrome (AIDS)-free prior to their first visit after 1 October 1994. The follow-up lasted 10 years or until 30 September 2015. We used parametric g-computation to estimate the effects of HCV infection and DAA treatment on mortality had participants initiated ART at study entry. Results Of the 3056 eligible participants, 58% were female and 18% had HCV. The estimated 10-year all-cause mortality risk in the scenario in which no PLwH had HCV was 10.4% (95% confidence interval [CI] 6.0-18.0%). The 10-year mortality risk difference for HCV infection was 4.3% (95% CI 0.4-8.9%) and the risk ratio was 1.4 (95% CI 1.0-1.9). The risk difference for DAA treatment was -3.8% (95% CI -9.2-0.9%) and the risk ratio was 0.8 (95% CI 0.6-1.1). Conclusions HCV co-infection remains an important risk factor for mortality among PLwH after initiating ART according to modern guidelines, and DAAs are effective at reducing mortality in this population. HCV prevention and treatment interventions should be prioritized to reduce mortality among PLwH.

Original languageEnglish (US)
Pages (from-to)1152-1159
Number of pages8
JournalClinical Infectious Diseases
Volume68
Issue number7
DOIs
StatePublished - Mar 19 2019

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Hepatitis C
Hepacivirus
HIV
Mortality
Infection
Virus Diseases
Antiviral Agents
Confidence Intervals
Therapeutics
Coinfection
Acquired Immunodeficiency Syndrome
Odds Ratio
Multicenter Studies
Cohort Studies
Guidelines

Keywords

  • antiretroviral therapy
  • direct-acting antivirals
  • hepatitis C virus
  • human immunodeficiency virus

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

The Effects of Hepatitis C Infection and Treatment on All-cause Mortality Among People Living With Human Immunodeficiency Virus. / Breskin, Alexander; Westreich, Daniel; Cole, Stephen R.; Hudgens, Michael G.; Hurt, Christopher B.; Seaberg, Eric Carl; Thio, Chloe L; Tien, Phyllis C.; Adimora, Adaora A.

In: Clinical Infectious Diseases, Vol. 68, No. 7, 19.03.2019, p. 1152-1159.

Research output: Contribution to journalArticle

Breskin, Alexander ; Westreich, Daniel ; Cole, Stephen R. ; Hudgens, Michael G. ; Hurt, Christopher B. ; Seaberg, Eric Carl ; Thio, Chloe L ; Tien, Phyllis C. ; Adimora, Adaora A. / The Effects of Hepatitis C Infection and Treatment on All-cause Mortality Among People Living With Human Immunodeficiency Virus. In: Clinical Infectious Diseases. 2019 ; Vol. 68, No. 7. pp. 1152-1159.
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AU - Breskin, Alexander

AU - Westreich, Daniel

AU - Cole, Stephen R.

AU - Hudgens, Michael G.

AU - Hurt, Christopher B.

AU - Seaberg, Eric Carl

AU - Thio, Chloe L

AU - Tien, Phyllis C.

AU - Adimora, Adaora A.

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N2 - Background Persons living with human immunodeficiency virus (HIV; PLwH) are commonly co-infected with hepatitis C virus (HCV). Most co-infected individuals can achieve a sustained HCV virologic response after treatment with direct-acting antivirals (DAA). However, the effect of HCV co-infection and DAA treatment on mortality after initiating antiretroviral therapy (ART) is unknown for PLwH. Methods We analyzed data from the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study. Participants included those who had prevalent HIV or seroconverted during follow-up; all were antiretroviral-naive and acquired immunodeficiency syndrome (AIDS)-free prior to their first visit after 1 October 1994. The follow-up lasted 10 years or until 30 September 2015. We used parametric g-computation to estimate the effects of HCV infection and DAA treatment on mortality had participants initiated ART at study entry. Results Of the 3056 eligible participants, 58% were female and 18% had HCV. The estimated 10-year all-cause mortality risk in the scenario in which no PLwH had HCV was 10.4% (95% confidence interval [CI] 6.0-18.0%). The 10-year mortality risk difference for HCV infection was 4.3% (95% CI 0.4-8.9%) and the risk ratio was 1.4 (95% CI 1.0-1.9). The risk difference for DAA treatment was -3.8% (95% CI -9.2-0.9%) and the risk ratio was 0.8 (95% CI 0.6-1.1). Conclusions HCV co-infection remains an important risk factor for mortality among PLwH after initiating ART according to modern guidelines, and DAAs are effective at reducing mortality in this population. HCV prevention and treatment interventions should be prioritized to reduce mortality among PLwH.

AB - Background Persons living with human immunodeficiency virus (HIV; PLwH) are commonly co-infected with hepatitis C virus (HCV). Most co-infected individuals can achieve a sustained HCV virologic response after treatment with direct-acting antivirals (DAA). However, the effect of HCV co-infection and DAA treatment on mortality after initiating antiretroviral therapy (ART) is unknown for PLwH. Methods We analyzed data from the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study. Participants included those who had prevalent HIV or seroconverted during follow-up; all were antiretroviral-naive and acquired immunodeficiency syndrome (AIDS)-free prior to their first visit after 1 October 1994. The follow-up lasted 10 years or until 30 September 2015. We used parametric g-computation to estimate the effects of HCV infection and DAA treatment on mortality had participants initiated ART at study entry. Results Of the 3056 eligible participants, 58% were female and 18% had HCV. The estimated 10-year all-cause mortality risk in the scenario in which no PLwH had HCV was 10.4% (95% confidence interval [CI] 6.0-18.0%). The 10-year mortality risk difference for HCV infection was 4.3% (95% CI 0.4-8.9%) and the risk ratio was 1.4 (95% CI 1.0-1.9). The risk difference for DAA treatment was -3.8% (95% CI -9.2-0.9%) and the risk ratio was 0.8 (95% CI 0.6-1.1). Conclusions HCV co-infection remains an important risk factor for mortality among PLwH after initiating ART according to modern guidelines, and DAAs are effective at reducing mortality in this population. HCV prevention and treatment interventions should be prioritized to reduce mortality among PLwH.

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