{"id":988,"date":"2014-04-22T15:07:01","date_gmt":"2014-04-22T15:07:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=988"},"modified":"2014-04-19T07:41:14","modified_gmt":"2014-04-19T07:41:14","slug":"hivhepatitis-c-co-infection-increases-risk-of-hepatic-decompensation","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2014\/04\/22\/hivhepatitis-c-co-infection-increases-risk-of-hepatic-decompensation\/","title":{"rendered":"HIV\/hepatitis C co-infection increases risk of hepatic decompensation"},"content":{"rendered":"

A recent study (Lo Re & Vincent<\/a> (L&J)) presents disquieting findings regarding the relative risk of severe liver complications in HIV\/Hepatitis C co-infected patients.<\/p>\n

Hepatitis C (HCV) has received particular attention in STIs recently on account of its strong association with HIV sero-positivity in MSM (Yaphe & Klein (STIs)<\/a>) and because of its growing incidence in some MSM populations (Giraudon & Barton (STIs)<\/a>).\u00a0 As for the outcomes of HCV in co-infected patients, there have been studies suggesting the benefit of ART in slowing progression of liver complications; but, L&J claim, theirs is the first to have established a significant difference in the outcomes of HIV co-infected patients.<\/p>\n

L&J is a retrospective cohort study involving the records of 10,359 patients receiving care between 1997 and 2010 through the US Veterans Health Administration.\u00a0 It establishes a relatively higher risk of hepatic decompensation for HCV co-infected, as opposed to HCV mono-infected patients:\u00a0 HR 1.83<\/b> or HR 1.56 <\/b>(depending on whether death is treated as a \u201ccompeting risk\u201d). \u00a0Cumulative incidence of decompensation at ten years for co-infected and mono-infected was, respectively, 7.4%<\/b> and 4.8%<\/b>.<\/p>\n

The study also gives an indication of the impact of levels of ART success (in terms of maintenance of HIV RNA levels) on rates of hepatic decompensation in co-infected patients.\u00a0 Co-infected patients who maintained HIV RNA levels at less than 1000 copies\/mL had lower rates of hepatic decompensation than patients who did not, but these rates were still considerably higher than for mono-infected patients: HR 1.44<\/b>.\u00a0 Cumulative incidence of decompensation at ten years for co-infected with HIV RNA \u2265 1000 copies\/mL was 7.6%<\/b>.<\/p>\n

In addition, the study examined various characteristics associated with higher levels of decompensation in co-infected patients – most interestingly, perhaps CD4 count at the study baseline.\u00a0 Cumulative incidence of decompensation at ten years for co-infected patients with CD4 <200×106 <\/sup>was 8.1%<\/b>, as against 6.9%<\/b> for co-infected with CD4 \u2265200×106<\/sup>.<\/p>\n

The authors conclude that the considerably greater risk of decompensation in co-infected patients is only somewhat alleviated by effective ART.\u00a0 They point out that their findings strongly support current guidelines for the earliest possible initiation of ART in co-infected patients, regardless of CD4 count, and may prompt earlier consideration of initiation of HCV to reduce the risk of liver complications<\/p>\n","protected":false},"excerpt":{"rendered":"

A recent study (Lo Re & Vincent (L&J)) presents disquieting findings regarding the relative risk of severe liver complications in HIV\/Hepatitis C co-infected patients. Hepatitis C (HCV) has received particular attention in STIs recently on account of its strong association with HIV sero-positivity in MSM (Yaphe & Klein (STIs)) and because of its growing incidence […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4351],"tags":[],"class_list":["post-988","post","type-post","status-publish","format-standard","hentry","category-hcvhiv-co-infection"],"yoast_head":"\nHIV\/hepatitis C co-infection increases risk of hepatic decompensation - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/04\/22\/hivhepatitis-c-co-infection-increases-risk-of-hepatic-decompensation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HIV\/hepatitis C co-infection increases risk of hepatic decompensation - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"A recent study (Lo Re & Vincent (L&J)) presents disquieting findings regarding the relative risk of severe liver complications in HIV\/Hepatitis C co-infected patients. 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