HIV-HCV co-infected patients are particularly concerned by liver disease due to immune activation/inflammation, exposure to antiretroviral agents and evolution of HCV co-infection. Polyphenols contained in coffee have several hepato-protective properties. Elevated coffee consumption has already been associated with a reduced risk of insulin resistance and lower levels of liver enzymes in co-infected patients (Carrieri et al. CID 2014, Carrieri et al. JHEPAT 2013). However its association with overall mortality is unknown. This study aimed to investigate the effect of coffee consumption and other behaviors on mortality risk in HIV-HCV co-infected patients.
The ANRS CO13 HEPAVIH cohort is a French nationwide prospective cohort of HIV-HCV co-infected patients with medical and psycho-social/behavioral data collection using self-administered questionnaires at enrolment (M0) and every 12 months thereafter until M60. The present study’s outcome was all-cause mortality reported between M0 and M60. We used a Cox proportional hazards model to study the effect of coffee consumption on mortality.
Over a median [IQR] follow-up of 5.0 [3.9-5.8] years, 77 deaths occurred among 1,035 eligible patients, corresponding to a mortality rate [95% CI] of 1.64 [1.31-2.05]/100 person-years. Leading causes of death were: related to HCV (including hepatocellular carcinoma, n=33, 43%), to cancers (unrelated to AIDS or HCV) (n=9, 12%), and to AIDS (n=8, 10%). Elevated coffee consumption (≥3 cups/day) was reported by 26.3% of the patients at M0. It was, as a time-varying covariate, significantly associated with a 50% reduced risk of mortality (HR [95%CI] = 0.5 [0.3-1.0], p=0.045), after adjustment for gender and other time-varying factors as follows: precarious housing, having a steady partner, alcohol and tobacco use, HIV stage, CD4+ cell count ≤200/mm3, HCV treatment status (ongoing treatment: HR [95%CI] = 0.9 [0.4-2.1]; treated but not cured: 0.6 [0.3-1.3]; treated and cured: 0.2 [0.1-0.5]; treatment naive: reference).
This study indicates a possible protective effect of elevated coffee intake on mortality in HIV-HCV co-infected patients. This association is independent of HIV immunological status and HCV clearance. As this effect may be mediated by coffee compounds having anti-inflammatory and anti-fibrotic properties, these results underline the need of evaluating the benefits of coffee extracts and supplementing dietary intake of other anti-inflammatory compounds in this population.