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African-American women with HIV/HCV less prone to liver-related death than Caucasians, Hispanics

African-American women had a lower risk for liver-related death compared with Caucasians and Hispanics within a cohort of HIV/HCV coinfected patients in a recent study.

Researchers evaluated 794 coinfected women, including 140 Caucasians, 159 Hispanics and 495 African-Americans. All patients had been enrolled in the Women’s Interagency HIV Study. Incidence of all-cause and liver-related mortality within this cohort was recorded.

Death occurred in 438 cases, including 49 liver-related deaths, in 56.4% of the Caucasian participants, 55.8% of the Africa-Americans and 52.2% of the Hispanic patients during a median follow-up of 8.9 years. The most common causes of death included HIV/AIDS (36.9% of cases), liver-related illness (11.2%) and homicide, suicide or accident (9.0%).

Liver disease was the primary cause of mortality for 20.5% of Hispanics, 13.9% of Caucasians and 7.6% of African-Americans who died during the study. Investigators observed a significant difference between liver-related mortality rates among African-American patients and those of Caucasian (HR=0.41; 95% CI, 0.19-0.88) and Hispanic participants (HR=0.38; 95% CI, 0.19-0.76). The reduction in risk remained for African-American patients after adjusting for cardiovascular (HR=0.44, 0.20-0.95 compared with Caucasians; HR=0.39, 0.19-0.80 vs. Hispanics), HIV-related (HR=0.41, 0.19-0.88 vs. Caucasians; HR=0.38, 0.19-0.76 vs. Hispanics) and liver-related risk factors (HR=0.46, 0.22-0.98 vs. Caucasians; HR=0.43, 0.22-0.87 vs. Hispanics) (95% CI for all).

Rates of all-cause mortality were not significantly different between the groups (P=.8), and liver-related mortality rates were similar between Caucasian and Hispanic patients. Competing-risks and survival analyses also indicated that non-liver-related mortality risk was similar between African-Americans, Hispanics and Caucasians.

“We observed novel, important racial/ethnic trends in this large cohort of HIV/HCV coinfected women,” the researchers concluded. “Compared to Hispanic and Caucasian coinfected women, African-American coinfected women were much less likely to die from liver-related disease, which did not appear to be the result of differential classification of cause of death. Previous data have revealed racial/ethnic differences in immunologic response to HCV, which may affect rates of liver fibrosis. Future studies incorporating fibrosis progression may help us to better understand these marked racial/ethnic discrepancies in liver-related mortality.”