February 7, 2001
There are large numbers of patients co-infected with HIV and hepatitis C. There are different reports regarding whether the interaction between the two infections worsens either disease. This is of importance for two reasons: the first is the need to understand the impact of treatment of one disease on the other, and the corollary is the impact of not treating one disease while treating the other. Sulkowski (see abstract 34) studied a cohort of approximately 750 chronic HCV/HIV-infected patients in Baltimore and found that "HCV did not adversely affect HIV disease progression or survival after controlling for use and effectiveness of HAART." The patients in this study were not treated for HCV and had no increased mortality due to either HCV or HIV if they were treated with antivirals.
In this study, Klein et al. performed a retrospective analysis of a clinical database of HIV-positive patients and compared all patients who were HCV positive with those who were HCV negative. The primary outcomes measured were AIDS-defined illnesses, hospitalizations and death. There were 500 patients in this database and there were differences between the groups in three areas that are relevant.
|Use of HAART baseline||23%||35%|
|Rate of Opportunistic Infections/person years||9.77||7.91|
|Rate of Death/person years||6.67||2.27|
The relative risk of death (p=.04) and hospitalization (p=.05) was significantly more for the co-infected group after adjustment for baseline, CD4, viral load, duration of infection, and use of HAART. The authors speculated that the increased risks for HCV were complex and related to a higher incidence of intravenous drug use and the attendant risks to that activity, as well as a lower incidence of HAART with concomitant progression of HIV disease. Torriani reported that the response in co-infected people to HAART may be less due to the concomitant hepatotoxicity and the need for monitoring and possible discontinuations of meds (see abstract 575).
The differences between the two studies may represent geographical differences or the greater use of HAART in the Baltimore cohort. We must always provide appropriate care of substance use and have resources to address persistent IVDU and the different medical needs that may arise. Comprehensive care should include HIV care, substance abuse care, and case management for the extra difficulties in caring for co-infected individuals.
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