Hepatic Decompensation in Antiretroviral-Treated Patients Co-Infected With HIV and Hepatitis C Virus Compared With Hepatitis C Virus-Monoinfected Patients A Cohort Study

• Type of Material: Article
• Authors: Vincent Lo Re, University of Pennsylvania; Michael J. Kallan, University of Pennsylvania; Janet P. Tate, VA Connecticut Healthcare System; A. Russell Localio, University of Pennsylvania; Joseph K. Lim, University of Pennsylvania; Matthew Bidwell Goetz, David Geffen School of Medicine at UCLA; Marina B. Klein, Baylor College of Medicine; David Rimland, Emory University; Maria C. Rodriguez-Barradas, Baylor College of Medicine; Adeel A. Butt, University of Pittsburgh School of Medicine; Cynthia L. Gibert, Washington DC VA Medical Center; Sheldon T. Brown, James J. Peters VA Medical Center and Mt. Sinai School of Medicine; Lesley Park, Yale University School of Medicine; Robert Dubrow, Yale University School of Medicine; K. Rajender Reddy, University of Pennsylvania; Jay R. Kostman, University of Pennsylvania; Brian L. Strom, University of Pennsylvania; Amy C. Justice, VA Connecticut Healthcare System
• Language: English
• Date: 2014-03-18
• Publisher: American College of Physicians
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 American College of Physicians.
• Final Published Version (URL): http://dx.doi.org/10.7326/M13-1829
• Title of Journal or Parent Work: Annals of Internal Medicine
• Volume: 160
• Issue: 6
• Start Page: 369
• End Page: 379
• Grant/Funding Information: Grant Support: National Institute of Allergy and Infectious Diseases research grant K01 AI070001 [Dr. Lo Re], National Institute on Alcohol Abuse and Alcoholism research grant U01 AA13566 [Dr. Justice], and National Institute of Mental Health research grant T32 MH020031 [Ms. Park].
• Keywords: VETERANS AGING COHORT; General & Internal Medicine; HIV/HCV COINFECTION; Life Sciences & Biomedicine; SOCIETY-USA PANEL; POLYMERASE CHAIN-REACTION; PROTEIN-S DEFICIENCY; FIBROSIS PROGRESSION; Science & Technology; CHRONIC LIVER-DISEASE; SIMPLE NONINVASIVE INDEX; HUMAN-IMMUNODEFICIENCY-VIRUS; Medicine, General & Internal; HEPATOCELLULAR-CARCINOMA
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: The incidence and determinants of hepatic decompensation have been incompletely examined among patients coinfected with HIV and hepatitis C virus (HCV) in the antiretroviral therapy (ART) era, and few studies have compared outcome rates with those of patients with chronic HCV alone. Objective: To compare the incidence of hepatic decompensation between antiretroviral- treated patients co-infected with HIV and HCV and HCV-monoinfected patients and to evaluate factors associated with decompensation among co-infected patients receiving ART. Design: Retrospective cohort study. Setting: Veterans Health Administration. Patients: 4280 co-infected patients who initiated ART and 6079 HCV-monoinfected patients receiving care between 1997 and 2010. All patients had detectable HCV RNA and were HCV treatment-naive. Measurements: Incident hepatic decompensation, determined by diagnoses of ascites, spontaneous bacterial peritonitis, or esophageal variceal hemorrhage. Results: The incidence of hepatic decompensation was greater among co-infected than monoinfected patients (7.4% vs. 4.8% at 10 years; P < 0.001). Compared with HCV-monoinfected patients, co-infected patients had a higher rate of hepatic decompensation (hazard ratio [HR] accounting for competing risks, 1.56 [95% CI, 1.31 to 1.86]). Co-infected patients who maintained HIV RNA levels less than 1000 copies/mL still had higher rates of decompensation than HCV-monoinfected patients (HR, 1.44 [CI, 1.05 to 1.99]). Baseline advanced hepatic fibrosis (FIB-4 score >3.25) (HR, 5.45 [CI, 3.79 to 7.84]), baseline hemoglobin level less than 100 g/L (HR, 2.24 [CI, 1.20 to 4.20]), diabetes mellitus (HR, 1.88 [CI, 1.38 to 2.56]), and nonblack race (HR, 2.12 [CI, 1.65 to 2.72]) were each associated with higher rates of decompensation among co-infected patients. Limitation: Observational study of predominantly male patients. Conclusion: Despite receiving ART, patients co-infected with HIV and HCV had higher rates of hepatic decompensation than HCVmonoinfected patients. Rates of decompensation were higher for co-infected patients with advanced liver fibrosis, severe anemia, diabetes, and nonblack race. Primary Funding Source: National Institutes of Health.