Meta-Analysis: Increased Mortality Associated With Hepatitis C in HIV-Infected Persons Is Unrelated to HIV Disease Progression

It is unclear whether co-infection with hepatitis C virus (HCV) increases mortality in HIV patients during the era of highly active antiretroviral therapy (HAART). Using meta-analysis, the study authors estimated the effect of HCV infection on HIV disease progression and overall mortality in the pre-HAART and HAART eras.

The databases PubMed and EMBASE were used to identify studies published through April 30, 2008. Additional studies were located via cited references. Studies reporting disease progression or mortality among HCV-HIV co-infected patients were included. Excluded were cross-sectional studies, those without HCV-negative control subjects, and studies involving children and/or patients who had undergone liver transplantation. Two authors reviewed articles and extracted data on risk estimates and demographic characteristics of study populations. Meta-regression was employed to explore heterogeneity.

Ten pre-HAART era studies and 27 from the HAART era were used. In the pre-HAART era, the risk ratio for overall mortality among HCV-HIV co-infected patients, compared with that among HIV patients alone, was 0.68 (95 percent confidence interval [CI], 0.53-0.87). In the HAART era, the risk ratio was 1.12 (95 percent CI, 0.82-1.51) for AIDS-defining illness and 1.35 (95 percent CI, 1.11-1.63) for overall mortality among co-infected patients, compared to HIV mono-infected patients.

"HCV co-infection did not increase mortality among patients with HIV infection before the introduction of HAART," the authors concluded. "In contrast, in the HAART era, HCV co-infection, compared with HIV infection alone, increases the risk of mortality, but not the risk of AIDS-defining events. Future studies should determine whether successful treatment of HCV infection could reduce this excess risk of mortality in co-infected patients."

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