title: Lower liver-related death in African-American women with human immunodeficiency virus/hepatitis C virus coinfection, compared to Caucasian and Hispanic women.
abstract: Among individuals with and without concurrent human immunodeficiency virus (HIV), racial/ethnic differences in the natural history of hepatitis C virus (HCV) have been described. African Americans have lower spontaneous HCV clearance than Caucasians, yet slower rates of liver fibrosis once chronically infected. It is not clear how these differences in the natural history of hepatitis C affect mortality, in either HIV-positive or -negative individuals. We conducted a cohort study of HIV/HCV coinfected women followed in the multicenter Women's Interagency HIV Study to determine the association of self-reported race/ethnicity with all-cause and liver-related mortality. Survival analyses were performed using Cox's proportional hazards models. The eligible cohort (n = 794) included 140 Caucasians, 159 Hispanics, and 495 African Americans. There were 438 deaths and 49 liver-related deaths during a median follow-up of 8.9 years and maximum follow-up of 16 years. African-American coinfected women had significantly lower liver-related mortality, compared to Caucasian (hazard ratio [HR], 0.41; 95% confidence interval [CI]: 0.19-0.88; P = 0.022) and Hispanic coinfected women (HR, 0.38; 95% CI: 0.19-0.76; P = 0.006). All-cause mortality was similar between racial/ethnic groups (HRs for all comparisons: 0.82-1.03; log-rank test: P = 0.8).
  
  
  CONCLUSIONS
  African-American coinfected women were much less likely to die from liver disease, as compared to Caucasians and Hispanics, independent of other causes of death. Future studies are needed to investigate the reasons for this marked racial/ethnic discrepancy in liver-related mortality.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA. monika.sarkar@ucsf.edu
authors.forename: Monika
authors.initials: M
authors.lastname: Sarkar
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Audrey L
authors.initials: AL
authors.lastname: French
authors.forename: Phyllis
authors.initials: P
authors.lastname: Tien
authors.forename: Marshall J
authors.initials: MJ
authors.lastname: Glesby
authors.forename: Marek
authors.initials: M
authors.lastname: Nowicki
authors.forename: Michael
authors.initials: M
authors.lastname: Plankey
authors.forename: Stephen
authors.initials: S
authors.lastname: Gange
authors.forename: Gerald
authors.initials: G
authors.lastname: Sharp
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000097:blood / Q000208:ethnology / Q000401:mortality*; D016174:Hepacivirus; D006526:Hepatitis C / Q000097:blood / Q000208:ethnology / Q000401:mortality*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008107:Liver Diseases / Q000208:ethnology / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D012367:RNA, Viral