Co-infection with Hepatitis C Virus Increases Mortality in HIV-1 infected Patients through Increased Liver-Related Deaths Rather Than By Increasing Malignancy Related Deaths
Year: 2016
Type: article
Study design: Observational Study
Abstract: Materials/Patients and MethodsWe performed an age and sex 1:1 matched case control study.We analyzed de-identified patient records from the North Shore University Hospital-LIJ Health System HIV clinic, a major suburban HIV clinic just outside the NY Metropolitan area, which follows 2,079 HIV-1infected patients.We evaluated all deaths (n=153) that occurred in this cohort for 5 years from January 1, 2010-December 31, 2014 (~10,000 patient life years) and classified the cause of death using the World Health Organization International Classification of Diseases diagnostic tool [18].An age and sex matched sample of living clinic patients was selected during 2014-2015 to serve as the reference population (n=153).A total of 395 patients were recruited randomly from the total clinic to serve as possible controls, and then age and sex matched controls were randomly selected to achieve 1:1 matching.Determination of patient age, sex, level of detectable virus in plasma, absolute CD4 count, Hepatitis C status, and antiretroviral therapy were obtained from review of the medical record.Last available recorded values were used.Age for living controls was as of September 9, 2015.Age for deceased was at time of death.Each categorization of cause of death was based on review of the death by a minimum of two clinicians active in the Abstract Background: HIV-1-infected patients are living longer since the introduction of highly effective antiretroviral therapy (HAART).There is evidence that hepatitis C virus (HCV)/HIV-1 co-infection may result in an increased risk of death compared to patients infected only with HIV-1.Prior studies looking at this association have been limited by their enrollment of populations composed of mainly young MSM males.We investigated HCV/HIV-1-co-infection for an increased odds ratio for all cause mortality in a cohort representative of the current population in the US living with HIV-1-infection. Methods:We performed an age-and-sex 1:1 matched case control study.We evaluated all deaths (n=153) that occurred in a cohort of ~2000 patients from January 1, 2010-December 31, 2014 (~10,000 patient life years) at a suburban clinic outside the NYC metropolitan area with a significant number of women and older individuals living with HIV-1-infection.We compared this cohort to an age and sex matched population selected from among 395 enrolled living HIV-1-infected controls. Results:We observed that HCV/HIV-1-co-infection was associated with an increased odds ratio for all cause mortality of 1.83 (95% CI, 0.99, 3.43; P=0.038) compared to HIV-1-mono-infected patients.Liver related deaths were the main cause of death with an odds ratio for liver related death with of 6.59 (95% CI, 1.70, 25.70; P=0.0005). Conclusion:In an HIV-1-infected cohort, HCV/HIV-1-co-infection is associated with an increased odds ratio for all cause mortality driven by liver related mortality.
Authors: Daniel O Griffin, Michael J Metzger
Institution: Columbia University Irving Medical Center
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W2590389759