Significant differences in clinical outcomes between HIV-hepatitis C co-infected individuals with and without injection drug use history

2013 | AIDS

Initiative(s): CANOC |

Abstract:

Objective: Studies focusing on HIV-hepatitis C (HCV) co-infected individuals without a history of injection drug use (IDU) are limited. It is plausible that poorer clinical outcomes in HIV-HCV co-infection are due to factors associated with IDU, not from HCV itself. This study compares HIV treatment outcomes and survival between HIV-HCV co-infected individuals with and without IDU history.

Design: Observational cohort study.

Methods: We analyzed data from a multisite Canadian cohort study of HIV-positive individuals initiating combination antiretroviral therapy (ART) after January 1, 2000. This analysis was restricted to 1,254 participants with HCV co-infection and known IDU history. Cox proportional hazards regression was used to evaluate time from ART initiation to virologic suppression (two consecutive measures <250 copies/mL) and CD4 cell count recovery (+100 cells/mm3). In order to account for loss to follow-up (LTFU), competing risk analysis was used to evaluate time to death.

Results: 1254 participants (31% female) were included. During a median follow-up time of 3.8 years (IQR = 2.1-6.2), 217 deaths were reported and 148 participants were LTFU. In adjusted multivariable analysis, individuals with IDU history were significantly less likely to achieve virologic suppression (AHR = 0.78, 95%CI = 0.64-0.95); marginally less likely to have CD4 count recovery (AHR = 0.82, 95%CI = 0.66-1.00); and had a significantly higher risk of death (AHR = 2.15, 95%CI = 1.25-3.70).

Conclusions: IDU history independently elevates risk for poorer clinical outcomes, separate from HCV co-infection. HIV-HCV co-infected persons are not homogeneous in characteristics or outcomes, suggesting care should be taken during statistical analyses if attributing poorer HIV-specific outcomes solely to HCV co-infection.

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Cescon A

BC Centre for Excellence in HIV/AIDS

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Significant differences in clinical outcomes between HIV-hepatitis C co-infected individuals with and without injection drug use history

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