To determine the effect of human immunodeficiency virus (HIV) on the natural history of HCV infection, Drs Margaret Ragni and Steven Belle evaluated end-stage liver disease (ESLD) in 157 hemophiliacs (85 HIV positive and 72 HIV negative) with HCV infection for an average of 24 years.
After adjusting for age at HCV infection, past or current hepatitis B surface antigen positivity, and history of alcohol abuse, the researchers from Pittsburgh, USA, determined that the rate of ESLD was significantly greater among HIV-positive than among HIV-negative hemophiliacs (relative risk [RR], 3.72; 95% confidence interval [CI], 1.25-11.09), as was the adjusted RR for death due to ESLD (RR, 3.81; 95% CI, 1.19-12.16).
Among HIV-positive hemophiliacs, the crude RR for ESLD was lower, but not significantly so, with antiretroviral treatment (RR, 0.19; 95% CI, 0.03-1.14; P=.069). It increased with each decade of HCV infection (RR, 2.26; 95% CI, 1.42-3.59; P=.0006) and HIV infection (RR, 2.18; 95% CI, 1.36-3.49; P=0.0013).
|End-stage liver disease was significantly greater among HIV-positive hemophiliacs
|Journal of Infectious Disease|
The authors conclude that their findings suggest that HIV accelerates HCV disease progression.
This study confirms the observations of Professors Christine Lee and Geoffrey Dusheiko, from London, England, who reported similar findings in last December's Gut.