We studied the effect of SVR on non–liver-related (NLR) non–AIDS-related (NAR) events and mortality in HIV/HCV+ patients (Pts) after therapy with interferon plus ribavirin (IR).
GeSIDA 3603 is a cohort of HIV/HCV+ Pts treated with IR between 2000-2008 in 19 centers. We assessed incident NLR-NAR events from interruption of IR to the last follow-up visit, death, or loss to follow-up. Pts were classified as responders (including those who achieved SVR after retreatment) or nonresponders. We assessed NLR-NAR deaths and NLR-NAR events, including cardiovascular events (myocardial infarction, angina, stroke, peripheral artery disease, heart failure, ruptured aortic aneurism, and mesenteric artery ischemia), renal events (chronic renal failure, dialysis, and renal transplantation), bone events (bone fractures and avascular bone necrosis), diabetes mellitus, NLR-NAR–defining cancer, and NAR sepsis requiring hospitalization. NLR-NAR events were defined according to the Cohort of the Spanish AIDS Research Network (AIDS 2013; 27:181). The censoring date was May 31, 2014. All the centers were monitored before the analysis. We calculated the aHR (95%CI) of events in responders vs nonresponders by Cox regression analysis. The variables for adjustment were age, sex, prior AIDS, HIV risk group, nadir CD4+ cell count, cART, HIV-RNA load, HCV genotype, and advanced fibrosis (FIB4≥3.25). Competing risk survival analysis was applied when analyzing NLR-NAR events (overall death) and NLR-NAR death (AR or LR death). Two sensitivity analyses were carried out: one by censoring FU in retreated patients with SVR at the date of initiation of retreatment and the other by excluding those who were retreated.
Of 1,625 Pts, 592 (36%) had an SVR. After a median FU of 5.2 y in responders and 5.5 y in nonresponders, significantly lower frequencies and rates of renal events, diabetes mellitus, and NAR sepsis were seen in responders (Table). Cox regression analysis showed that the aHR of renal events and diabetes mellitus were significantly lower in responders (Table). These results were confirmed by the 2 sensitivity analyses.
Our findings suggest that eradication of HCV in coinfected Pts is independently associated with a reduced hazard of renal events and diabetes mellitus. Eradication of HCV was not independently associated with a reduced hazard of NLR-NAR death, cardiovascular events, bone events, NLR-NAR cancers, or NAR sepsis.