Impact of hepatitis C cure on risk of mortality and morbidity in people with HIV after antiretroviral therapy initiation.  AIDS
Chalouni et al. for the Antiretroviral Therapy Cohort Collaboration (ART-CC) aimed to assess the risks of overall mortality, AIDS-defining events, and non-AIDS-defining nonliver-related (NANL) cancers between hepatitis C virus (HCV-) co-infected people with HIV (PWH) who reached sustained virological response (SVR) and matched mono-infected PWH with similar time since first starting antiretroviral therapy (ART).
Among 62’495 PWH, 2’756 acquired HCV, of whom 649 reached SVR. For 582 of these, at least one mono-infected PWH could be matched, producing a total of 5’062 mono-infected PWH. The estimated hazard ratios comparing HCV-co-infected PWH who reached SVR with mono-infected PWH were 0.29 [95% confidence interval (CI) 0.12–0.73] for mortality, 0.85 [0.42–1.74] for AIDS-defining events, and 1.21 [0.86– 1.72] for NANL cancer.
In conclusion, when compared with mono-infected PWH, PWH with HCV co-infection for a short time and who reached SVR, whatever the treatment generation, were at lower risk of overall mortality. Nevertheless, participants who reached SVR after a direct acting agents (DAA-) based treatment still exhibited a higher risk of NANL cancer after SVR, despite an important incertitude in the estimate with a large confidence interval. Treatment guidelines and the limited efficacy of pre-DAA HCV treatments could have resulted in a selection of the SVR population and, therefore, artificially decreased the risk of events in the SVR population. A study comparing HIV mono-infected participants and HCV-cured participants following highly effective DAA treatment could overcome this issue.