November 12, 2001
Investigators at the Universitaetsklinikum in Bonn, Germany report their experience with co-infected patients. It has been widely reported that hepatitis C infection takes a more aggressive course in HIV/HCV co-infected patients and can lead to advanced liver disease such as cirrhosis, liver failure and hepatocellular carcinoma. With the introduction of HAART and longer survival, it's been theorized that co-infected patients may have increased morbidity and mortality from hepatitis C infection.
The objective of this study was to clarify whether HAART in fact affects liver-related and total mortality in co-infected patients. This was a retrospective study of the Bonn HIV Cohort which has been followed since 1990. The study group consisted of 285 patients, of whom 94 had received HAART. In the entire group, 107 patients died and 25 of these deaths were liver-related.
In the patients receiving HAART, only eight deaths were observed and only two of these deaths were related to HCV-related liver disease. Kaplan-Meyer survival analysis confirmed a total survival benefit for the HIV/HCV co-infected patients receiving HAART with a mean survival of 2,658 days versus 1,679 days. HAART-treated patients also had lower liver-related mortality, surviving a mean of 2,186 days versus 2,119 days; however, this difference did not reach statistical significance.
This study shows that HAART reduces mortality in HIV/HCV co-infected patients just as it does in non-co-infected patients. Most importantly, this study does not support the hypothesis that liver-related mortality increases in HIV/HCV co-infected patients receiving HAART therapy and therefore there is no rationale to withhold HAART from HIV/HCV co-infected patients.
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