Racial difference in mortality among U.S. veterans with HCV/HIV coinfection.
OBJECTIVE
This study was performed to examine the impact of viral coinfections and race on clinical and virological outcome of hepatitis C virus (HCV) infection.


METHODS
Three groups of patients (265 HCV/HIV coinfected, 251 HCV monoinfected, 227 HIV monoinfected) were identified between 2000 and 2002 from the computerized patient record system at the Philadelphia VA Medical Center and analyzed for clinical and virological parameters.


RESULTS
HCV/HIV coinfection was associated with higher frequency of liver function abnormalities (37% vs 21% vs 20%; p < 0.0003) and greater mortality (17% vs 6% vs 9% over 3 yr period, p = 0.0003, p = 0.027) compared to HCV or HIV monoinfection, respectively. However, HCV/HIV coinfection was not associated with worsened HIV-related parameters (CD4 count, HIV titer, and use of antiretroviral therapy) or increased HCV titers compared to HIV or HCV monoinfection in our population, respectively. Interestingly, mortality among HCV/HIV coinfected patients was significantly greater in white than in black patients (31% vs 15%, p = 0.011). This racial disparity in mortality was not apparent in the monoinfected groups and not explained by HBV coinfection or history of alcohol use disorder.


CONCLUSIONS
We conclude that HCV/HIV coinfection is associated with worsened liver disease and higher mortality than HCV- or HIV-monoinfection without directly influencing CD4 count and HCV or HIV titers. Furthermore, we demonstrated a racial disparity in survival of HCV/HIV-coinfected patients that needs further investigation.
Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Nathan A
NA
Merriman
Steven B
SB
Porter
Colleen M
CM
Brensinger
K Rajender
KR
Reddy
Kyong-Mi
KM
Chang
D000437:Alcoholism / Q000150:complications; D044383:Black People / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000208:ethnology / Q000401:mortality* / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D019562:Viral Load; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American