Is response to anti-hepatitis C virus treatment predictive of mortality in hepatitis C virus/HIV-positive patients? AIDS
Peters et al. The Hepatitis C Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord aimed to compare the long-term risk of all-cause mortality and liver-related death according to response to pegylated interferon + ribavirin in HIV/HCV coinfected people enrolled in the large prospective multicohort study Collaboration of COHERE. Patients were categorized into “responders” (last HCV-RNA measured between 24 and 72 weeks after baseline negative), “nonresponders” (HCV-RNA positive between 24 and 72 weeks after baseline) and “unknown response” (HCV-RNA unknown).
Overall, 3’755 patients were included: 1’031 (27.5%) responders, 1’639 (43.6%) nonresponders and 1’085 (28.9%) with unknown response. Rates (per 1’000 person-years of follow-up) of all-cause death were 17.59 for nonresponders, 10.43 for responders, and 11.00 for unknown responders, respectively. After adjustment, the relative hazard (nonresponders vs. responders) for all-cause death, liver-related death and nonliver-related death was 1.53, 3.39, and 1.22, respectively.
In conclusion, the study-results show that among HIV/HCV coinfected patients a favourable virological response to HCV treatment is associated with reduced risk of both liver-related death and improved overall survival in the interferon era. There was no difference in risk of nonliver-related death when comparing responders and nonresponders. However, as interferon is contraindicated in patients with advanced cirrhosis due to the risk of liver decompensation, it is likely that patients with more advanced liver disease were excluded in this study. It is therefore conceivable that with the new tolerable and effective interferon-free direct-acting antivirals, one will be able to prevent more liver-related and, possibly, nonliver-related complications.