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HCV/HIV coinfection increases mortality risk from any cause

Deaths from all causes and those specifically liver-related were more common among patients coinfected with HIV and HCV than the general population and among patients with HIV alone in a recent study.

Researchers evaluated data from 5,914 HIV-positive patients enrolled in two multicenter cohort studies in Spain between 1997 and 2008. Standardized mortality ratios (SMR) and excess mortality rates were compared between HCV-negative and HCV-positive patients within the cohort as well as the general population.

During the study, 231 patients died, with 10.4% of those deaths related to the liver. The all-cause mortality rate was 1.22 deaths per 100 person-years (1.07-1.39) for the entire cohort, 0.61 per 100 person-years (0.47-0.78) for HCV-negative patients and 1.96 per 100 person-years (1.68-2.28) among HCV-positive patients (95% CI for all). The excess mortality rate within the cohort was 1.0 deaths per 100 person-years (0.8-1.1), 0.35 (0.26-0.49) among HCV-negative patients and 1.79 (1.53-2.10) among HCV-positive patients (95% CI for all).

The SMR for death from any cause was 5.6 (95% CI, 4.9-6.4) for the entire cohort, compared with 2.4 (95% CI, 1.9-3.1) among HCV-negative participants and 11.5 (95% CI, 9.9-13.4) for HCV-positive patients. SMRs were consistently higher within the cohort than in the general population. Patients with both HCV and AIDS had an SMR of 20.8 (95% CI, 16.5-26.1), compared with 4.8 (95% CI, 3.5-6.7) among AIDS patients without HCV coinfection.

Patients with HCV also were more prone to death from liver failure, with an SMR of 1.8 (0.6-5.7) for liver-related mortality among HCV-negative participants compared with 22.4 (14.6-34.3) among HCV-positive participants, and an SMR of 9.4 (6.3-13.9) for the entire cohort (95% CI for all). Excess mortality rates because of liver-related causes were 0.23 per 100 person-years (0.15-0.36) among HCV-positive patients, compared with 0.01 per 100 person-years (0.00-0.07) among HCV-negative patients and 0.11 per 100 person-years (0.07-0.17) for the entire cohort (95% CI for all).

“Coinfection with HCV seems to play a very important role in all-cause and liver-related excess mortality,” the researchers wrote. “Rapid changes in the epidemiology of HCV coinfection and major advances in the treatment of these infections are likely to shape future patterns of excess mortality in the coming years.”