title: Clinical Liver Disease Progression Among Hepatitis C-Infected Drug Users With CD4 Cell Count Less Than 200 Cells/mm(3) Is More Pronounced Among Women Than Men.
abstract: Background.  Hepatitis C virus (HCV) infection is a leading cause of liver-related morbidity and mortality in the United States, and injection drug users are at particularly high risk. Methods.  This prospective observational cohort study assessed the rate of, and risk factors for, clinical liver disease progression in a cohort of HCV monoinfected and human immunodeficiency virus (HIV)/HCV coinfected drug users using unadjusted and multivariate Cox proportional hazards regression analyses. Results.  Of 564 subjects including 421 (75%) with HIV/HCV coinfection and 143 with HCV monoinfection, 55 (10%) had clinical liver disease progression during follow-up with a rate of 25.3 events per 1000 person-years. In unadjusted analysis, there was an interaction between sex and HIV status. In sex-stratified multivariate analysis, HIV/HCV-coinfected women with CD4 <200 cells/mm(3) had 9.99 times the risk of liver disease progression as HCV-monoinfected women (confidence interval [CI], 1.84-54.31; P = .008), and white women had a trend towards increased risk of liver disease progression compared with non-white women (hazard ratio, 2.84; CI, .93-8.68; P = .07). Human immunodeficiency virus/HCV-coinfected men with CD4 <200 cells/mm(3) had 2.86 times the risk of liver disease progression as HCV-monoinfected men (CI, 1.23-6.65; P = .01). Conclusions.  Hepatitis C virus-monoinfected and HIV/HCV-coinfected drug users had high rates of clinical liver disease progression. In those with HIV infection, liver disease progression was associated with advanced immune suppression. This effect was strikingly more pronounced in women than in men.
authors.affiliation: Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology; Department of Medicine, Section of Infectious Diseases.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Baranoski
authors.affiliation: Department of Epidemiology; Department of Medicine, Section of Infectious Diseases.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cotton
authors.affiliation: Department of Biostatistics , Boston University School of Public Health.
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.affiliation: Department of Medicine , Section of Gastroenterology , Boston University School of Medicine , Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Nunes
authors.affiliation: Department of Medicine , Section of Infectious Diseases.
authors.forename: Rachel W
authors.initials: RW
authors.lastname: Kubiak
authors.affiliation: Department of Epidemiology; Department of Medicine, Section of Infectious Diseases.
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
keywords: HCV; HIV; drug abuse; drug user