title: Effect of HCV infection on cause-specific mortality after HIV seroconversion, before and after 1997.
abstract: OBJECTIVE
  Individuals with human immunodeficiency virus (HIV) infection frequently also are infected with hepatitis C virus (HCV) (co-infection), but little is known about its effects on the progression of HIV-associated disease. We aimed to determine the effects of co-infection on mortality from HIV and/or acquired immune deficiency syndrome (AIDS), and hepatitis or liver disease, adjusting for the duration of HIV infection.
  
  
  METHODS
  We analyzed data from the 16 cohorts of the Concerted Action on Seroconversion to AIDS and Death in Europe (CASCADE) collaboration, which included information on HCV infection and cause of death. A competing-risks proportional subdistribution hazards model was used to evaluate the effect of HCV infection on the following causes of death: HIV- and/or AIDS-related, hepatitis- or liver-related, natural, and non-natural.
  
  
  RESULTS
  Of 9164 individuals with HIV infection and a known date of seroconversion, 2015 (22.0%) also were infected with HCV. Of 718 deaths, 395 (55.0%) were caused by HIV infection and/or AIDS, and 39 (5.4%) were caused by hepatitis or liver-related disease. Among individuals infected with only HIV or with co-infection, the mortality from HIV infection and/or AIDS-related causes and hepatitis or liver disease decreased significantly after 1997, when combination antiretroviral therapy became widely available. However, after 1997, HIV and/or AIDS-related mortality was higher among co-infected individuals than those with only HIV infection in each risk group: injection drug use (adjusted hazard ratio [aHR], 2.43; 95% confidence interval [CI], 1.14-5.20), sex between men and women or hemophilia (aHR, 3.43; 95% CI, 1.70-6.93), and sex between men (aHR, 3.11; 95% CI, 1.49-6.48). Compared with individuals infected with only HIV, co-infected individuals had a higher risk of death from hepatitis or liver disease.
  
  
  CONCLUSIONS
  Based on analysis of data from the CASCADE collaboration, since 1997, when combination antiretroviral therapy became widely available, individuals co-infected with HIV and HCV have had a higher risk of death from HIV and/or AIDS, and from hepatitis or liver disease, than patients infected with only HIV. It is necessary to evaluate the effects of HCV therapy on HIV progression.
authors.affiliation: Public Health Service Amsterdam, Amsterdam, the Netherlands. jvdhelm@ggd.amsterdam.nl
authors.forename: Jannie
authors.initials: J
authors.lastname: van der Helm
authors.forename: Ronald
authors.initials: R
authors.lastname: Geskus
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.forename: Julia
authors.initials: J
authors.lastname: Del Amo
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Maria
authors.initials: M
authors.lastname: Dorrucci
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
mesh_terms: D002423:Cause of Death; D015331:Cohort Studies; D060085:Coinfection / Q000276:immunology / Q000401:mortality* / Q000503:physiopathology; D016001:Confidence Intervals; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000401:mortality* / Q000503:physiopathology; D006679:HIV Seropositivity / Q000276:immunology / Q000401:mortality* / Q000503:physiopathology; D006526:Hepatitis C / Q000276:immunology / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis