Previous studies have found changes in lipids and inflammatory biomarkers after HCV cure, but there is little data on clinical endpoints in HIV/HCV coinfected persons. We investigated the impact of HCV coinfection status and clearance of HCV-RNA following treatment on the risk of non-AIDS malignancies (NADM), cardiovascular disease (CVD) and end-stage liver disease (ESLD) in HIV/HCV infected persons in the EuroSIDA study.
All HIV positive persons with known HCV status after January 2001 were included and stratified into five groups based on time-updated HCV-RNA and use of HCV treatment: 1) HCV-uninfected, 2) spontaneously resolved HCV infection, 3) Chronic untreated HCV infection, 4) Successfully treated HCV infection, 5) HCV-RNA positive despite previous HCV treatment. Separate analyses were performed with each clinical event (fatal and non-fatal) ESLD (including hepatocellular carcinoma, HCC), NADM (excluding HCC) and CVD (myocardial infarction, stroke, angioplasty, coronary bypass, carotid endarterectomy). Poisson regression was used to compare incidence rates between HCV groups.
A total of 15,524 HIV positive persons were included. The majority were male (74%), White (87%), on cART (85%) and current smokers (55%) with a median (IQR) age of 41 (35-49) years and CD4 cell count of 446 (290-641) cells/µl. During a median of 6.6 (IQR 2.3–12.6) person years of follow up (PYFU), a total of 694 CVD, 710 NADM and 375 ESLD events occurred; crude incidence rates/1000 PYFU (95% CI) were 6.1 (5.7–6.6) for CVD, 6.2 (5.8–6.7) for NADM and 3.2 (2.9–3.6) for ESLD. In univariable and multivariable analysis, there were no differences in incidence of both NADM and CVD between those who were untreated, had cleared HCV-RNA after HCV treatment and those with chronic infection (figure). In contrast, the incidence of ESLD was significantly lower among persons who had cleared HCV-RNA after treatment compared to those with chronic infection, and similar to those with spontaneous HCV-RNA clearance.
Although HCV cure has been shown to perturb levels of lipid and inflammatory biomarkers, studies of HIV/HCV coinfected persons have lacked power to focus on clinical events. We found no evidence of any impact of HCV infection status or HCV treatment on incidence of both NADM and CVD in coinfected persons while successful HCV treatment significantly lowered the incidence of ESLD to what was observed for those with spontaneous HCV-RNA clearance.