Risk of Developing Specific AIDS-Defining Illnesses in Patients Co-Infected With HIV and Hepatitis C Virus With or Without Liver Cirrhosis

The authors wrote that "with the exception of lymphoma," there are "few data concerning the risk of specific opportunistic diseases in patients with and without hepatitis C virus (HCV) infection." In the current study, they evaluated "the correlation between the occurrence of different AIDS-defining illnesses (ADIs) and chronic HCV infection or HCV-related liver cirrhosis" in a large cohort of HIV-positive persons in Italy.

The study subjects were stratified into two groups: patients without HCV co-infection and with persistently normal aminotransferase levels, and patients with HCV co-infection. The patients with HCV co-infection were stratified according to the diagnosis of liver cirrhosis. Incidences of new ADIs were calculated as the number of events per 1,000 person-years of follow-up. A Poisson regression model adjusted for potential confounders was used to compare the rates in the two groups.

"We observed a total of 496 ADIs among 5,397 patients with 25,105 person-years of follow-up (50 percent tested positive for HCV)," the authors wrote. HCV was found to be associated with increased risk of developing an ADI (adjusted relative rate [ARR], 2.61; 95 percent confidence interval [CI], 1.88-3.61), in particular bacterial infection (ARR, 3.15; 95 percent CI, 1.76-5.67), HIV-related disease (ARR, 2.68; 95 percent CI, 1.03-6.97), and mycotic disease (ARR, 3.87; 95 percent CI, 2.28-6.59) but not non-Hodgkin lymphoma (ARR, 0.88; 95 percent CI, 0.22-3.48).

The results indicated that the rates of mycotic infection, bacterial infection, toxoplasmosis and HIV-related ADI among patients with cirrhosis were significantly higher than among patients infected with HIV only, and the risk was greater than that estimated for HCV antibody-positive patients without cirrhosis.

"In conclusion, we found that HIV-HCV co-infected patients in our cohort were at a two-fold increased risk of developing AIDS than were HIV-monoinfected patients," the authors wrote. "Bacterial and mycotic infection and HIV-related disease are the ADIs more strongly associated with positive HCV serostatus and also with HCV-related cirrhosis. Clinicians should take these data into account in their clinical management of HCV-co-infected patients, in particular when deciding when to start antiretroviral therapy."

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