Survival of HIV/HCV co-infected patients before introduction of HCV direct acting antivirals (DAA)

Area of Science:

• Infectious Diseases
• Hepatology
• Immunology

Background:

• HIV/HCV co-infection is often presumed to reduce survival compared to HIV mono-infection.
• Combined antiretroviral therapy (cART) has improved outcomes for HIV patients.
• Direct-acting antivirals (DAAs) for HCV have revolutionized treatment, but their impact on long-term survival in co-infected patients prior to their widespread use is less understood.

Purpose of the Study:

• To compare long-term survival and causes of death in HIV-mono-infected versus HIV/HCV-co-infected patients receiving cART before the DAA era.
• To identify independent factors associated with long-term survival in this cohort.
• To assess the impact of HCV co-infection on survival outcomes under cART.

Main Methods:

• A cohort study involving 322 Caucasian patients (176 with HIV, 146 with HIV/HCV) recruited between 2003-2004 and followed until 2014.
• Kaplan-Meier method was used to compare overall survival between the two groups.
• Conditional Cox regression analysis identified independent predictors of long-term survival.

Main Results:

• Overall survival did not differ significantly between HIV/HCV co-infected and HIV mono-infected patients (p=0.619).
• Complete suppression of HIV replication (< detection level) was associated with substantially better survival than residual viremia (p=0.001).
• Independent predictors of survival included age (p=0.008), gamma-glutamyltransferase (p<0.0001), and bilirubin (p=0.008), irrespective of HCV co-infection.

Conclusions:

• Complete suppression of HIV replication on cART is the primary determinant of survival in both HIV and HIV/HCV co-infected patients.
• HCV co-infection and pre-DAA era therapy had a lesser impact on survival than previously assumed.
• Patients with HIV/HCV co-infection require particularly intensive cART management to achieve optimal outcomes.