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.
Link to abstract
• 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.
Full article requires payment
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.
• This analysis compared mortality rates in well-controlled HIV+ adults in the SMART and ESPRIT trials with those in the general population.
Link to free article
• 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.