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Liver-related death among HIV/HCV coinfected individuals, implications for the era of directly acting antivirals
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[5 year probability of death 9-12% among those with liver fibrosis F2 or greater vs 0.6-0.8%...15 times greater if < F2.....hazard ratio 28.4 for F2 or more vs < F2] ...... "LRD accounted for 27% of all deaths in HIV/HCV coinfected patients in EuroSIDA, on par with AIDS as the leading cause of death......The rate of LRD peaked between the ages 35-45 and was highest in the West Central and North regions.......LRD occurred almost exclusively among those with significant liver fibrosis (Metavir ≥F2) and HCV treatment with DAAs should be prioritised for this group. In Eastern Europe, where the prevalence of HCV coinfection is highest, the rate of LRD remains low with causes of death dominated by AIDS and non-LRD......The rate of LRD peaked in those aged 35-40.....LRD rates were far higher among those with low CD4 cell counts and LRD occurred almost exclusively among those with ≥F2 liver fibrosis......Among those with ≥F2 fibrosis 5-year probabilities of LRD were substantial; 9.2% (6.5% - 12.9%) in those with baseline CD4 ≥200cells/mm3 and 12.3% (7.6% - 19.5%) in those with baseline CD4 <200cells/mm3 (P<0.0001).....vs.....The 5-year probability of LRD was negligible in those with < F2 liver fibrosis; 0.6% (95% CI: 0.3% -1.1%) in those with baseline CD4 ≥200cells/mm3 and 0.8% (0.2% - 2.5%) in those with baseline CD4 <200cells/mm3."
Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA
D Grint1, L Peters2, A Rakmanova3, J K Rockstroh4, I Karpov5, M Galli6, P Domingo7, O Kirk2, J D Lundgren2, A Mocroft1 for EuroSIDA in EuroCoord
1UCL, London, UK; 2Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark; 3Botkin Hospital of Infectious Diseases, St Petersburg, Russia; 4Department of Medicine I, University of Bonn, Bonn, Germany;
5Belarus State Medical University, Minsk, Belarus; 6Sacco hospital, Milan, Italy; 7Hospital de Sant Pau, Barcelona, Spain
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