Since the advent of direct acting antiviral drugs (DAA) for hepatitis C (HCV) treatment, end-stage liver disease has been overtaken by other, non-HCV-related causes of death among people coinfected with HIV and HCV, a Canadian study published in AIDS found.
Researchers compared data for two periods, 2003-2012 and 2013-2017 (before and after the DAA use began in Canada), and stratified participants into two age groups, 20-49 years old and 50-80 years old. Forty-two percent of the 1,634 study participants received at least one course of HCV treatment; 68% of these were with DAAs.
The overall death rate was 32.9 per 1,000 person-years, with 2% of deaths related to AIDS, 18% to drug overdoses, and 17% to liver disease. During 2013-2017, liver disease as a cause of death was overtaken by drug overdoses in the younger group and smoking-related illnesses in the older group. However, people with advanced liver fibrosis and poor HIV control still died from liver issues in either period.
HCV treatment should prioritize those with advanced fibrosis and interventions targeting modifiable risk factors should be included in routine HIV/HCV care, study authors recommended.