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Accelerated Mortality found in HCV/HIV coinfected in Salvage Study OPTIMA; trends in HCV/HIV coinfection prevalence in UK
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--HCV/HIV Coinfection at BHIVA Conference April 2006
"The effect of hepatitis C virus (HCV) on HIV progression in a late salvage population: results from the OPTIMA (OPTions In Management with Antiretrovirals) Study"
Fiona Ewings1, Brian Angus1, Sheldon Brown2, William Cameron3, Mark Holodniy4,m Tassos Kyriakides5, Joel Singer6 and Abdel Babiker1
1UK MRC HIV CTU, London, UK, 2Bronx VAMC, NY, USA, 3University of Ottawa, Ottawa, Canada, 4VA Paolo Alto HCS, CA, USA, 5VA Cooperative Studies, West Haven, CT, USA, 6Canadian HIV Trials Network, Vancouver, Canada
Aims: Studies on the effect of co-infection with HCV on HIV progression have
yielded conflicting results. We aimed to investigate this effect in a late salvage
population. Study conducted in USA, UK, Canada.
Methods: Using data from OPTIMA, the effect of HCV on survival and
progression to a new AIDS event or death was evaluated using Cox models
controlling for treatment and baseline CD4.
Results:
Of the 311 patients for whom HCV status and follow-up data were available, 72 (23%)were HCV+. The median (range) follow-up time was 21 (0.7, 47) and 23 (0.3, 47) months for HCV+ and HCV) patients respectively.
25% of HCV+ patients died compared to 16% of HCV) patients.
Injecting-drug use was reported as a possible mode of HIV transmission by 74% of HCV+ patients compared with only 26% of HCV-negative) patients.
There was evidence to suggest that HCV is associated with impaired survival [HR = 1.79, 95% CI (1.01-3.16), P=0.045]. The effect size
was similar after adjusting for mode of transmission [HR = 1.70 (0.86-3.36),
P=0.13], but after further controlling for (time-dependent) number of ART drugs the effect was much attenuated [HR = 1.37 (0.67, 2.80), P=0.39]. The median (range) time to first switch/stop of on-study ART was 3.8 (0.03, 36) and 6.5 (0.03,
46) months in HCV+ and HCV) patients, respectively. HCV+ patients were no more likely than HCV-negative) patients to experience an AIDS event during follow-up (23%versus 25%). We found no statistically significant effect of HCV on time to a new AIDS event or death [HR = 1.32 (0.84, 2.08), P=0.23].
Conclusion: Co-infection with HCV appears to increase the risk of mortality, but this effect might be partly explained by a shorter time to switching/stopping ART. One possible reason may be that HCV+ patients are less able to tolerate ART.
Trends in HCV/HIV Coinfection Prevalence in UK: increased testing in all HIV+ individuals results in lower proportion of infected patients
"Hepatitis C virus (HCV) co-infection in HIV-infected
patients in the UK Collaborative HIV Cohort (CHIC) Study"
Joanna Turner1, Loveleen Bansi2, Richard Gilson1 and Caroline Sabin2
1Centre for Sexual Health and HIV Research, Royal Free and UC Medical School,
London, 2Department of Primary Care and Population Sciences, Royal Free and
UC Medical School, London, UK
Aims: To describe trends in HCV testing and prevalence of HCV co-infection in
the UK CHIC Study.
Methods: Data from all centres in the UK CHIC study that contributed HCV antibody test data were included in the analysis (six of seven centres).
Results:
11,357/18,630 (61.0%) patients had had at least one HCV antibody
test.
9,386 (86.6%) of these patients were male, 7,770 (68.74%) white, 427
(3.8%) were injection-drug users (IDUs) and 7,806 (68.7%) were homosexual;
the median age of those tested was 36.3 (IQR: 31.4, 42.1) years.
The proportion of patients tested increased over time, with 369/5,204 (7.1%) patients undergoing follow-up in 1995 having been tested at some time,
2,861/8,233 (34.8%) in 2000 and 8,033/10,219 (78.6%) in 2004.
1,045/11,357 (9.2%, 95% CI: 8.7-9.7) of the patients tested for HCV antibody had at least one positive result with the proportion of positive results falling over time - 94/369 (25.5%) in 1995, 369/2861 (12.9%) in 2000 and 648/8,033
(8.1%) in 2004.
Among those with a test result, factors independently associated with detectable HCV antibody were earlier calendar year of test, younger age, female gender, injection-drug use and black African ethnicity.
Conclusion: As there has been a move towards testing all individuals for HCV, rather than only those felt to be at high risk, the proportion of patients testing positive for HCV antibody has decreased. Further analyses will determine the incidence of HCV infection and the impact of HCV-HIV co-infection on response to HAART.
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