Highly active antiretroviral therapy improves ESLD-free  survival in HIV-HCV co-infection.
The impact of highly active antiretroviral therapy (HAART) on progression to end-stage liver disease (ESLD) in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection remains controversial. We studied 157 HCV+ haemophilic men (85 HIV+ and 72 HIV-), on whom dates of HIV and HCV seroconversion and clinical outcomes were known. Time to ESLD was determined by Kaplan-Meier product-limit methods and risk factors for ESLD progression were analysed by a Cox proportional hazards model. Among HIV+ men, ESLD was more common, 17 of 85 (20.0%) than in HIV-, eight of 72 (11.1%) and median ESLD-free survival significantly shorter, P = 0.009, hazard ratio 3.00 [95% confidence interval (CI): 1.27-7.08]. HAART treated HIV+ had longer ESLD-free survival than HIV+ untreated, 30.3 vs. 20.0 years, P = 0.043, hazard ratio, 3.14 (95% CI: 1.27-7.08), comparable with survival in HIV- men, P = 0.13, hazard ratio 2.20 (95% CI: 0.76-2.35). Progression was unrelated to HAART toxicity (n = 0) or HCV antiviral therapy (n = 7). HIV+ HAART Rx and HIV- did not differ in HCV duration, age at ESLD, age at death or present, overall or AIDS mortality, all P > 0.05. These data suggest that HAART improves ESLD-free survival, approaching that in HIV- men.
Department of Medicine, Division Hematology/Oncology, University of Pittsburgh Medicine Center, Pittsburgh, PA 15213-4306, USA. ragni@dom.pitt.edu
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Ragni
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Nalesnik
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Schillo
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Dang
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018450:Disease Progression; D015497:HIV-1 / Q000276:immunology; D006467:Hemophilia A / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D002836:Hemophilia B / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D016174:Hepacivirus / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D017093:Liver Failure / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D008297:Male; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome