XIX International AIDS Conference


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WEAB0102 - Oral Abstract

Increased risk of hepatic decompensation and hepatocellular carcinoma in HIV/HCV-co-infected patients compared to HCV-mono-infected patients despite combination antiretroviral therapy

Presented by Vincent Lo Re (United States).

V. Lo Re1,2, J. Tate3,4, M. Kallan1, J. Lim3,4, M. Goetz5, M. Klein6, D. Rimland7, M. Rodriguez-Barradas8, A. Butt9, C. Gibert10, S. Brown11, J. Kostman1, B. Strom1, R. Reddy1, A. Justice3,4, R. Localio1

1Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States, 2Philadelphia VA Medical Center, Philadelphia, United States, 3VA Connecticut Healthcare System, West Haven, United States, 4Yale University School of Medicine, New Haven, United States, 5VA Greater Los Angeles Healthcare System, Los Angeles, United States, 6McGill University Health Centre, Montreal, Canada, 7Atlanta VA Medical Center, Atlanta, United States, 8Michael E. DeBakey VA Medical Center, Houston, United States, 9VA Pittsburgh Healthcare System, Pittsburgh, United States, 10Washington DC VA Medical Center, Washington, United States, 11James J. Peters VA Medical Center, New York, United States

Background: Few studies have examined the natural history of chronic hepatitis C virus (HCV) infection among HIV-infected persons in the era of combination antiretroviral therapy (cART). Our objectives were to: 1) compare the incidence of hepatic decompensation between cART-treated HIV/HCV-coinfected and HCV-monoinfected patients, and 2) evaluate determinants of decompensation among coinfected patients on cART.
Methods: We performed a cohort study among 4,286 cART-treated HIV/HCV-coinfected and 6,639 HCV-monoinfected patients in the Veterans Aging Cohort Study Virtual Cohort (1997-2010). All patients had HCV viremia and were HCV treatment-naïve. Coinfected patients received cART for at least one year and had an HIV RNA result >500 copies/mL within 180 days prior to starting cART (to identify new cART initiators). Hepatic decompensation events (defined by diagnoses of ascites, spontaneous bacterial peritonitis, variceal hemorrhage, or hepatocellular carcinoma) and death were evaluated. Cox regression was used to determine the adjusted hazard ratio (aHR) of hepatic decompensation associated with cART-treated coinfection and evaluated baseline risk factors for decompensation (alcohol abuse, non-black race, diabetes mellitus, FIB-4 >3.25, hemoglobin < 10 g/dL, and pre-cART CD4 count) in coinfected patients on cART.
Results: Compared to HCV-monoinfected patients, cART-treated HIV/HCV-coinfected had a higher cumulative incidence and risk of hepatic decompensation (303/4,286 [7.1%] versus 370/6,639 [5.7%]; aHR=1.76 [1.50-2.06]) and hepatocellular carcinoma (50/4,286 [1.2%] versus 60/6,639 [0.9%]; aHR=1.69 [95% CI=1.14-2.49]). After decompensation, mortality was higher in coinfected patients (228/303 [75.2%] vs. 210/370 [56.8%]; p< 0.001). Non-black race (aHR=1.96 [1.53-2.49]), baseline FIB-4 >3.25 (aHR=7.18 [5.12-10.07]), and baseline hemoglobin < 10 g/dL (aHR=2.86 [1.62-5.07]) were associated with decompensation among coinfected patients.
Conclusions: Despite cART, HIV/HCV-coinfected patients had a higher risk of hepatic decompensation and death compared to HCV-monoinfected individuals. Risk of decompensation was higher for coinfected patients with advanced liver fibrosis, severe anemia, and non-black race.

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