Highly active antiretroviral therapy (HAART) has improved the prognosis of HIV infection.
Hepatitis C virus (HCV) is not inhibited by HAART, and treatment-related hepatotoxicity can occur in coinfected patients.
In this study, physicians from Germany assessed the effect of HAART in patients with both HIV and HCV.
The team studied both liver-related and overall mortality in 285 patients, between 1990 and 2002. Patients were divided into 3 groups depending on treatment:
They retrospectively analyzed patient survival using Kaplan-Meier and Cox's regression analyses.
- HAART (n = 93)
- nucleoside analogues only (n = 55)
- no treatment (n = 137)
|No patient died from drug-related hepatotoxicity.|
The physicians found that liver-related mortality rates were 0•45, 0•69, and 1•70 per 100 person-years in the HAART, antiretroviral-treatment, and untreated groups, respectively.
The team's analysis of liver-related mortality confirmed the survival benefit in patients treated using antiretroviral therapy.
They identified HAART, antiretroviral treatment, CD4-positive T-cell count, serum cholinesterase, and age as independent predictors of liver-related survival.
The physicians found severe drug-related hepatotoxicity in 5 patients treated with nucleoside analogues alone and 13 treated with HAART. No patient died from drug-related hepatotoxicity.
Dr Nazifa Qurishi's team concluded, "In addition to improved overall survival, antiretroviral therapy significantly reduced long-term liver-related mortality in our patients".
"This survival benefit seems to outweigh by far the associated risks of severe hepatotoxicity".