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Changing Epidemiology of HCV Mortality and Morbidity in HIV Patients
Changing Epidemiology of HCV Mortality and Morbidity in HIV Patients
Changing Epidemiology of HCV Mortality and Morbidity in HIV Patients
Jrgen K. Rockstroh
Department of Internal Medicine I
University Hospital Bonn
Germany
Conflict of interest
I have received honoraria for speaking at educational
events or consulting from:
Abbott, Abbvie, Bionor, BMS, Boehringer, Gilead,
Janssen, Merck, Novartis, Pfizer, Roche, Tibotec,
Tobira and ViiV
Background
HIV accelerates the natural course of hepatitis particularly
with declining CD4 counts1
Liver disease associated with HCV infection has become
a leading cause of morbidity and mortality among
HIV-infected patients
Group B-D
(n=191)
p < 0.001
90
80
Group A (n=49)
70
30
40
50
Time (months)
60
70
P=0.0006
50
No PI Exposure
40
30
20
PI Exposure
10
0
10
15
20
25
30
Cumulative Survival
Cumulative Survival
HAART*
0,8
0,6
ART
0,4
*P<0.001
0,2
1000
2000
No therapy
3000 4000
Days
6000
Liver-Related Mortality
HAART*
ART
0,8
No therapy
0,6
0,4
0,2
5000
*P=0.018
0
1000
2000
3000 4000
Days
5000
6000
60
50
P=0.005
P=0.004
P=0.005
50
49
49
41
40
39
37
31
30
20
10
0
P=0.05
P=0.04
<400
400-99K
>100k
>350
<350
<400
>400
(n=141)
(n=117)
(n=16)
(n=124)
(n=150)
(n=100)
(n=88)
HIV RNA
CD4
(copies/mL)
(cells/mm3)
0.26
0.01
0.1
0.125
0.17
0.25
0.5
10
HIV/HCV
on ART
Baseline
Follow-up
Start of
Follow-up
Study Endpoint
Death
HCV Therapy
12 mo
in VA
HCV
Baseline
Follow-up
Start of
Follow-up
Study aim: To compare the incidence of hepatic decompensation between ARTtreated HIV/HCV-coinfected and HCV-monoinfected pts
Hepatic decompensation was defined as a hospital diagnosis indicated by ICD9 code or two or more outpatient diagnoses of ascites, spontaneous bacterial
peritonitis, or esophageal variceal hemorrhage
Lo Re V, et al. 19th IAC; Washington, DC; July 22-27, 2012; Abst. WEAB0102.
on
competing risk
regression
analysis.
ART-Treated
HIV/HCV-Coinfected
HCV-Monoinfected
Log-rank
p<0.001
HD risk was 83% higher in the coinfected group (aHR 1.83, 95% confidence interval [CI] 1.54 to 2.18)
Lo Re V, et al. 19th IAC; Washington, DC; July 22-27, 2012; Abst. WEAB0102.
Activity Score
*
*
7
6
5
4
3
2
1
0
Viral Load
Undetectable
Mehta SH et al. Hepatology 2005
Viral Load
Detectable
ART
49
P=0.002
50
40
33
30
24
19
20
13
10
0
-41
-2
n=16
n=64
n=50
33
n=64
74
n=37
ART
P for
trend=0.02
8
7,5
7
6,5
6
5,5
5
-41
n=20
-2
n=51
n=51
33
74
n=66
n=35
Rohrbach J, et al. CROI 2009. Abstract 105, Rohrbach J, et al. GUT 2010;59:1252-1258
1Mohan
HAART
(b)
Initiation of ART
Condition
>500
R
C
R
R
C
C
2009-2011
N=548
3,802 deaths in 49,734 HIV positive individuals followed for 304,695 person-years
Death rate fell from 17.4 deaths per 1000 py in 1999-2000 to 8.3 deaths in 2009-2011
Weber R, et al. 19th IAC; Washington, DC; July 22-27, 2012; Abst. THAB03104.
Overall
mortality
Liver
decompensation
1,600
1,400
1,599
1,200
1,000
800
600
400
695
200
0
274 (35%)