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17 April 2013

HIV, age, and the severity of hepatitis C virus-related liver disease: a cohort study.

Kirk GD et al. Ann Intern Med 2013 Feb 26. [Epub ahead of print].

• This observational cohort study investigated whether HIV+ individuals develop HCV-related liver disease at a younger age than HIV– individuals by comparing the severity of liver fibrosis by age.
• Of 1,176 HCV+ individuals, 34% were also HIV+.
• The prevalence of clinically significant fibrosis without cirrhosis (12.9% versus 9.5%) and of cirrhosis (19.5% versus 11.0%) was greater in HIV/HCV coinfected individuals versus individuals with HCV only (p<0.001).
• Increasing age and HIV infection were independently associated with liver fibrosis, as were daily alcohol use, chronic HBV infection, BMI >25 kg/m2 and higher plasma HCV RNA levels.
• When these factors were kept constant, HIV+ individuals had liver fibrosis measurements equal to those of HIV– individuals, who were, on average, 9.2 years older.
• Conclusion: In this cohort, HIV/HCV coinfected individuals had liver fibrosis stages similar to HIV– individuals who were nearly a decade older.

25 March 2013

Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population.

Rodger A et al. AIDS 2013;27:973–9.

• This analysis compared mortality rates in well-controlled HIV+ adults in the SMART and ESPRIT trials with those in the general population.
• Non-IDUs aged 20–70 years from the continuous ART control arms of ESPRIT and SMART were included if they had a low VL (≤400 copies/mL SMART, ≤500 copies/mL ESPRIT) and a high CD4 count (≥350 cells/mm3) at any time in the previous 6 months (n=3,280; 12, 357 person-years of follow-up).
• Standardized mortality ratios (SMRs) were calculated by comparing death rates with the Human Mortality Database.
• Sixty-two deaths occurred during follow up. The most frequent cause of death was cardiovascular disease or sudden death (19, 31%), followed by non-AIDS malignancy (12, 19%). Only two deaths (3%) were AIDS related.
• The mortality rate was increased versus the general population in individuals with a CD4 count of 350–499 cells/mm3 (SMR 1.77; 95% CI: 1.17–2.55). There was no evidence for increased mortality in those with a CD4 count ≥500 cells/mm3 (SMR 1.00; 95% CI: 0.69–1.40).
• Conclusion: Compared with the general population, there was no evidence for an increased risk of death in HIV+ individuals on ART who had a recent undetectable VL and a CD4 count ≥500 cells/mm3.