Hepatitis C and HIV Outlook

posted: 18/11/2009

We can now say that having both hepatitis C and HIV doesn’t make it any more likely people will go on to develop an AIDS illness, but people do have a worsened chance of dying early.

One third higher risk of early death

A massive study of all the studies, a ‘meta-analysis’ of over 100,000 people has produced these findings. Since effective HIV treatment became available in the mid 1990s, co-infected people still have a 35% higher risk of death compared to people with just HIV.

The investigators believe that that “the major contributor to mortality among co-infected subjects during the HAART [highly active antiretroviral therapy] era is likely to be liver disease.”

HIV treatments mean that many people with HIV can look forward to a long and healthy life. However, the outlook for people with both HIV and hepatitis C is significantly shorter than for people who only have HIV.

Indeed, liver-related disease is now an important cause of death in HIV/hepatitis co-infected patients. Although there is a lot of evidence showing that HIV accelerates the course of hepatitis C disease, there is less agreement about the effect of hepatitis C on HIV disease progression.

A team of US investigators therefore conducted a meta-analysis of 37 studies published before April 2008 to see what impact hepatitis C had on HIV disease progression and overall mortality.

Before HIV treatments experience
Ten of the studies were before effective antiretroviral therapy became available. These studies showed that before HIV treatment became available, people with both HIV and hep C were slightly less likely to face worsening HIV than people who only had HIV – not a worsening in HIV health as you might have expected.
This part of the analysis had 4413 people with both hep C and HIV and 10,213 individuals who only had HIV.

After HIV treatments
They then looked at studies after 1996 when modern HIV treatments became available. This part of the analysis had 25,319 people with both hep C and HIV and 61,697 people with only HIV. These showed that people with both hep C and HIV were 35% more likely to die early compared with people who only have HIV.

Older, on treatment, how long with hep C
People with both hep C and HIV who were older, or taking antiretroviral therapy had an especially higher risk of death.

Moreover, the longer someone has both hep C and HIV, then the greater the risk of earlier death.

End outcome
The results from the meta-analysis depend on whether you stop the clock when people get AIDS, or follow people until they die. If you stopped the clock at an AIDS diagnosis, then the results show there is no difference between people who only have HIV and those with hep C as well. But in life, none of us have time machines that can prevent our dying. Therefore we should pay more attention to the 36% higher risk of dying early with hep C.

Seven studies in the meta analysis looked at how hep C and HIV affected disease progression, whether this was defined as either an AIDS diagnosis or death. Co-infected people were 49% more likely to get AIDS or die early than people who only have HIV..

Liver disease likely killer
“The majority contributor to mortality among co-infected subjects during the HAART (highly active antiretroviral therapy) era is likely to be liver disease”, comment the investigators. “The meta-analysis did not demonstrate increased risks of developing AIDS-defining events among co-infected patients”, conclude the investigators.
 

What next?
They recommend that “future studies that attempt to examine mortality among coinfected subjects should attempt to determine the relative contributions of hepatitis C viremia as a surrogate marker for liver disease risk, whether injecting drug use is current…, and whether broader application of hepatitis C treatment positively impacts mortality in co-infected individuals.”

Source

Chen T-Y et al. Meta-analysis: increased mortality associated with hepatitis C in HIV-infected persons is unrelated to HIV disease progression. Clin Infect Dis 49 (10): 1605-1615, 2009.

photo credit and hepatitis c gene quilt panel 

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