Highlights
- •Similar rates of SVR exist between HIV/HCV co-infected and HCV mono-infected participants.
- •There is a higher risk of all-cause deaths, non-liver-related deaths, and cancers in HIV/HCV co-infected participants.
- •There is a similar risk of liver-related deaths and liver-related events in both populations.
Background & Aims
Direct-acting antivirals (DAA) lead to high sustained virological response (SVR) rates
and decrease the risk of disease progression. We compared SVR rates and all-cause,
liver- and non-liver-related deaths, liver-related events, and non-liver-related cancers
in HIV/HCV-coinfected and HCV-monoinfected participants from 2 French cohort studies
after initiation of DAA treatment.
Methods
Up to 4 HCV-monoinfected participants from the ANRS CO22 HEPATHER cohort were matched
by age and sex to each HIV/HCV-coinfected patient from the ANRS CO13 HEPAVIH cohort;
both are nationwide, prospective, multicentre, and observational. Participants were
initiated on DAAs between March 2014 and December 2017. Cox proportional hazards models
adjusted by age, sex, duration since HCV diagnosis, HCV transmission routes, HCV genotypes,
cirrhosis, tobacco, alcohol consumption, and SVR (time dependent) were used.
Results
A total of 592 HIV/HCV-coinfected and 2,049 HCV-monoinfected participants were included;
median age was 53.3 years (inter-quartile range: 49.6–56.9) and 52.9 years (49.6;
56.7), 1,498 (73.1%) and 436 (73.6%) were men, and 159 (28.8%) and 793 (41.2%) had
cirrhosis, respectively. SVR was observed in 92.9% and 94.6%, respectively. HIV coinfection
was associated with higher risk of all-cause death (hazard ratio [HR] 1.93; 95% CI
1.01–3.69), non-liver-related death (HR 2.84; 95% CI 1.27–6.36), and non-liver-related
cancer (HR 3.26; 95% CI 1.50–7.08), but not with liver-related-death (HR 1.04; 95%
CI 0.34–3.15) or liver-related events (HR 0.66; 95% CI 0.31–1.44).
Conclusions
After DAA treatment, HIV-coinfected individuals had similar SVR rates and risk of
liver-related deaths and events compared with HCV-monoinfected individuals, but had
a higher risk of all-cause and non-liver-related deaths and non-liver-related cancers.
Lay summary
We compared the risk of several clinical events in participants infected by human
immunodeficiency virus and hepatitis C virus with those infected with hepatitis C
virus alone, matched on age and sex, after treatment with contemporary direct-acting
antivirals. We found a higher risk of all-cause deaths, non-liver-related deaths,
and non-liver-related cancers in participants coinfected with the human immunodeficiency
virus and hepatitis C virus, and no differences for the risk of liver-related deaths
or events.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: August 13, 2020
Accepted:
August 11,
2020
Received in revised form:
July 16,
2020
Received:
April 20,
2020
Footnotes
Author names in bold designate shared co-first authorship
Clinical Trials registration: ANRS CO13 HEPAVIH: NCT03324633; ANRS CO22 HEPATHER: ClinicalTrials.gov Identifier: NCT01953458.
Identification
Copyright
© 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
