Non-liver-related deaths higher among HIV/HCV coinfected patients despite DAA treatment

The direct-acting antiviral (DAA) era has balanced the sustained virological response (SVR) and liver-related mortality risk between patients monoinfected with the hepatitis C virus (HCV) and those with HIV coinfections, a recent study has found. However, those with HCV/HIV coinfections continue to experience a higher overall mortality risk, driven mainly by non-liver-related deaths.

Researchers enrolled 592 coinfected participants (median age, 53.3 years; 73.1 percent male) and 2,049 HCV-monoinfected comparators (median age, 52.9 years; 73.6 percent male). The primary study outcomes, compared between groups, were SVR rates, death from various causes, liver-related events, and non-liver-related cancers.

SVR rates were similarly high in both coinfected and monoinfected patients (92.9 percent vs 94.6 percent). Taking treatment and concomitant cirrhosis into account altered the individual rates slightly, but did not lead to notable between-group differences.

The risk of liver-related deaths was likewise statistically comparable between coinfected and monoinfected patients after DAA treatment (HIV infection as a risk factor: hazard ratio [HR], 1.09, 95 percent confidence interval [CI], 0.35–3.35).

However, HIV coinfection did significantly raise the risk of all-cause mortality even after DAA treatment (HR, 1.99, 95 percent CI, 1.04–3.83). This effect could be attributed to non-liver-related events, which were more likely to occur in patients who also had HIV (HR, 2.92, 95 percent CI, 1.29–6.60). Coinfection also significantly increased the likelihood of non-liver-related cancers (HR, 3.26, 95 percent CI, 1.49–7.10).