Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response.
Data on the effects of sustained virologic response (SVR) to hepatitis C virus (HCV) therapy on the outcome of extrahepatic complications are scarce. We conducted this study to assess the impact of SVR on the occurrence of chronic kidney disease (CKD), diabetes mellitus (DM), and cardiovascular disease (CVD) in a cohort of human immunodeficiency virus (HIV)-infected patients. We analyzed coinfected HIV/HCV patients in the Management of Standardized Evaluation of Retroviral HIV Infection (MASTER) cohort. Only event-free patients with a serum HCV-RNA determination at baseline were included. Patients were divided into four groups: INF-exposed with SVR; INF-exposed without SVR; spontaneous HCV clearance; untreated viremic patients. We estimated the incidence of extrahepatic complications and employed Kaplan-Meier curves and Cox regression to assess the association of SVR/INF strata adjusted for a series of confounders. Data from 1676 patients were analyzed (20.29 % started an INF-based regimen). Overall, the incidence of CKD, DM, CVD, and death was 5.32 [95 % confidence interval (CI) 3.99-6.98], 10.13 (95 % CI 8.20-12.37), 6.79 (95 % CI 5.26-8.65), and 13.49 (95 % CI 11.29-16.0) per 1000 person-years of follow-up, respectively. In the Cox model for treated patients, SVR was not associated with a lower risk of CKD, DM, CVD, and death compared to non-SVR. Cirrhosis was significantly associated with a higher risk of CKD [hazard ratio (HR) 2.13; 95 % CI 1.06-4.31], DM (HR 3.48; 95 % CI 2.18-5.57), and death (HR 6.18; 95 % CI 4.1-9.31), but not of CVD (HR 1.14; 95 % CI 0.57-2.3). There are still many unknowns regarding the impact of SVR on the occurrence of extrahepatic complications in coinfected HIV/HCV patients. Further investigations are needed in order to elucidate the role of SVR as an independent prognostic factor for extrahepatic events.
Infectious Diseases Division, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy. sebastianoleone@yahoo.it.|Infectious Diseases Division, "San Giuseppe Moscati" Hospital, Avellino, Italy. sebastianoleone@yahoo.it.
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Leone
Department of Epidemiology, University of Florida, Gainesville, FL, USA.
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Prosperi
Infectious Diseases Division, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy.
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Costarelli
University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy.
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Nasta
Infectious Diseases Division, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
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Maggiolo
Clinic of Infectious Diseases, Policlinico Gemelli, USSC, Rome, Italy.
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Di Giambenedetto
Clinic of Infectious Diseases, Policlinico Hospital, University of Bari, Bari, Italy.
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Saracino
Infectious Diseases Division, "Santa Maria Annunziata" Hospital, Florence, Italy.
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Di Pietro
Infectious Diseases Division, "San Gerardo" Hospital, University of Milano-Bicocca, Monza, Italy.
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Gori
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors; D016019:Survival Analysis; D000072230:Sustained Virologic Response
D000998:Antiviral Agents