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Impact of Hepatitis Coinfection on Health & Survival
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Several studies at Retrovirus reported the negative impact of having hepatitis on HIV-infected individuals. In a study of 5300 gay men from the MACS cohort followed from 1984 to 2000. About half of these men had HIV. 6% had HBV. The liver related deaths were 10 times higher in those who were HIV/HBV coinfected vs. those who were HBV monoinfected. The death rate from liver disease has doubled in HIV/HBV coinfected patients in the post-HAART era (like what we've seen with HCV). In this study, 2 factors seemed to increase risk for death for coinfected patients -- patients with low CD4 counts during the HAART era tended to be more at risk for death and liver-related deaths increased after the HAART era began in 1996. 7% of these gay men who died of liver-related causes were found to have HCV.
Doctors from the Atlanta VA Medical Center looked at all HIV+ patients who tested positive for the hepatitis C virus from 1992-2001. Of 1069 patients 31% had HCV. These patients were mostly black, over 45 years of age, and IVDUs. The time it took for patients to progress from an HIV diagnosos to AIDS was the same for HCV+ and HCV-negative patients. But once patients had AIDS, HCV+ patients had significantly shortened time to death compared to patients without HCV.
Researchers studied 850 HIV-infected patients at 3 HIV Outpatient Study sites (called HOPS) where there were large numbers of HCV/HIV coinfected patients. 37% had HCV. The coinfected patients were more likely than patients with only HIV to be older, less educated, insured by Medicaid, and have IV drug use as their risk factor for HIV. Coinfected patients were more likely to have AIDS, kidney disease, heart disease, and a higher death rate. The interesting finding in this study was that coinfected patients did not have worse survival if they took HAART. This suggests that coinfected patients may be less likely to take or to be prescribed HAART.
Researchers from Johns Hopkins University School of Medicine studied hospitalization rates for patients in their HIV clinic from 1995 to 2000. The 3300 patients were mostly male and African-American (77%) with IVDU as their primary risk factor for HIV. Overall hospitalization rates were similar for coinfected patients and patients only with HIV prior to 1998. But hospitalization rates were significantly higher for coinfected patients from 1998-2000: 31% of coinfected patients were hospitalized for liver-related complications compared 10% of the HCV-negative patients; coinfected patients were hospitalized more for IVDU complications than HCV-negative patients (27% vs 15%).
Researchers from the CDC reported on 14,000 persons infected with HCV/HIV coinfection or infected only with HIV. They followed patients from 1998 to 2001 from the Adult/Adolescent Spectrum of HIV Disease (ASD) project, which is a study that follows the medical records of HIV-infected patients in 11 cities. Coinfected patients were less likely to receive HAART. Only 6% of coinfected patients received the hepatitis A vaccine. Once coinfected patients were told they had HCV they tended to drink less alcohol but 20% continued to drink alcohol. We need awareness programs to help coinfected patients stop drinking alcohol.
Marion Peters and a research group from the University of California at San Francisco reported on 4000 HIV+ patients receiving care in a care network in San Francisco from 1996 to 2000. 76% had been tested for hepatitis, and 9% had HBV and 39% had HCV. Coinfected patients were much more likely to have continuously elevated ALT liver enzymes. Peters found that doctors were more likely to withold HAART from coinfected patients regardless of their HIV status.
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