AEGiS-15IAC: Is hepatitis C infection an independent risk for death among persons with HIV infection on highly active antiretroviral therapy?

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Is hepatitis C infection an independent risk for death among persons with HIV infection on highly active antiretroviral therapy?

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1325)

Sullivan PS, Hanson DL, Teshale E, Brooks JT, Wolfe MI
Centers for Disease Control and Prevention, Atlanta, United States

BACKGROUND: Prevalence of coinfection with hepatitis C (HCV) is high among HIV-infected persons. Despite numerous studies, controversy persists as to whether coinfection is associated with poorer survival.

METHODS: We used data from the Adult and Adolescent Spectrum of HIV Disease project, a longitudinal medical records review study in 10 US cities. We performed survival analyses using proportional hazards regression to describe time from first observation on highly active antiretroviral therapy to death. We modeled the association between prevalent HCV infection and survival with and without controlling for comorbid conditions which could be clinically or statistically confounding (e.g., associated with both HCV infection and decreased survival: alcoholic or drug-induced hepatitis, recent alcohol abuse, history of ever injecting drugs, and acute and chronic hepatitis B infection). We also controlled for viral load, CD4 cell count, age, and risk for HIV infection.

RESULTS: The analyses included 16,677 persons; HCV prevalence was 19%, and 1052 deaths occurred during followup. HCV infection was associated shorter survival time (univariate hazard ratio (HR) 1.3; p< 0.01). When controlling for confounding factors, HCV prevalence was not associated with poorer survival (HR 0.9, p = 0.22); however, ever injecting drugs (HR=1.4), alcoholic hepatitis (HR 6.4), recent alcohol abuse (HR 1.3), chronic HBV infection (HR 1.3), acute HBV infection (HR 2.5), and drug-induced hepatitis (HR 1.6) were all independently associated with increased hazard of death (p<0.01) in the same model.

CONCLUSIONS: In our analysis, prevalent HCV infection was not associated with shorter survival after controlling for other important confounding risks. Studies of the potential impact of HCV infection on HIV disease progression should carefully control for these factors.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Hepatitis C, HIV Infections, CD4 Lymphocyte Count, Viral Load, Hepacivirus, Anti-HIV Agents, HIV, Prevalence, Communicable Diseases, Substance Abuse, Intravenous, Hepatitis B, Death, Hepatitis B, Chronic, Acquired Immunodeficiency Syndrome, Adolescence, Adult

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WeOrB1325