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HCV eradication in HIV coinfected patients linked to reduced diabetes, chronic renal failure

Eradication of hepatitis C virus infection among patients coinfected with HIV was associated with reductions in diabetes and chronic renal failure in addition to reduced mortality, HIV progression and liver-related events, according to the results of a Spanish cohort study.

These findings led investigators to conclude that HIV coinfected patients should receive HCV therapy regardless of their fibrosis stage.

To study the effects of sustained virologic response on non–liver-related and non–AIDS-related events among patients with HCV/HIV coinfection, investigators evaluated 1,625 such patients who were treated with interferon and ribavirin between 2000 and 2008, and were followed up through May 2014 (median age, 40 years; 75% men; median follow up, about 5 years).

The non–liver-related and non–AIDS-related events they assessed included diabetes, chronic renal failure, cardiovascular events, non–liver-related and non–AIDS-related cancer, bone events, and non–AIDS-related infections, and they adjusted their analysis for age, sex, prior AIDS, HIV-transmission category, nadir CD4+ T-cell count, antiretroviral therapy, HIV-RNA, liver fibrosis, HCV genotype, and exposure to certain anti-HIV drugs.

Overall, 36% of the patients achieved SVR, 6.2% developed cancer, 6% developed diabetes, 5.6% had cardiovascular events, 5% had non–AIDS-related infections, 3.5% had bone-related events and 2% had renal events.

The investigators found SVR was associated with significant reductions in overall death (HR = 0.36; 95% CI, 0.24-0.54), liver-related death (sub-HR = 0.13; 95% CI, 0.06-0.28), new AIDS-defining events (sHR = 0.37; 95% CI, 0.17-0.79), liver decompensation (sHR = 0.1; 95% CI, 0.05-0.21), hepatocellular carcinoma (sHR = 0.13; 95% CI, 0.03-0.5) and liver transplantation (sHR = 0.12; 95% CI, 0.02-0.78).

Further, regarding non–liver-related and non–AIDS-related events, SVR was associated with a significant reduction in the risk for diabetes (sHR = 0.57; 95% CI, 0.35-0.93) and a nearly significant reduction in the risk for chronic renal failure (sHR = 0.42; 95% CI, 0.17-1.09).

“Although the study design precludes determination of causality, our results suggest that eradication of HCV in coinfected patients is associated not only with a reduction in overall death, liver-related death, new AIDS-related events, and all types of liver-related events, but also with a statistically significant reduced hazard of diabetes mellitus and a decline in the hazard of chronic renal failure very close to the threshold of significance,” the researchers concluded. “These findings argue for the prescription of HCV therapy regardless of liver fibrosis stage in coinfected patients.” – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.