School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
J Viral Hepat. 2013 Jul;20(7):463-9. doi: 10.1111/jvh.12107. Epub 2013 Apr 25.
The impact of pretreatment anaemia on survival in individuals with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection is not known. Moreover, HCV treatment is offered less frequently to individuals with anaemia, due to haematological side effects of the treatment regimen. This study aimed to determine the effect of HCV treatment on survival among HCV/HIV co-infected individuals with pretreatment anaemia using the Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES). Individuals with HCV/HIV co-infection were included in current analyses. Participants were considered treated if they were prescribed ≥ 4 weeks of HCV treatment. All-cause mortality data were obtained using record linkage. Survival analyses were performed using Cox proportional hazard models. Among 5000 HCV/HIV co-infected individuals, 1671 (33.4%) had pretreatment anaemia. In a follow-up period of up to 7 years (19,500 person-years), individuals with anaemia had significantly higher mortality rate compared with those without anaemia [144.2 (95% CI: 134.5-154.7) vs 47.5 (44.0-51.2) per 1000 person-years, respectively]. Among individuals with anaemia, HCV treatment was associated with significantly lower mortality rate [66.6 (44.3-100.2) vs 149.6 (139.2-160.5) per 1000 person-years, for treated vs untreated, respectively]. Treatment remained associated with substantial survival benefit after taking into account the effect of multiple comorbidities (hazards ratio: 0.34, 95% CI: 0.21-0.62). These data suggest that HCV/HIV co-infected individuals with pretreatment anaemia have significantly higher mortality compared with those without anaemia. HCV treatment is associated with substantial survival benefit in this group. Additional studies are needed to determine strategies to improve HCV treatment rates among this group.
在丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）合并感染个体中，预处理贫血对生存的影响尚不清楚。此外，由于治疗方案的血液学副作用，贫血患者接受 HCV 治疗的频率较低。本研究旨在使用电子检索 HCV 感染退伍军人队列（ERCHIVES）确定预处理贫血的 HCV/HIV 合并感染个体中 HCV 治疗对生存的影响。目前的分析包括 HCV/HIV 合并感染的个体。如果患者接受了≥4 周的 HCV 治疗，则认为他们接受了治疗。通过记录链接获得全因死亡率数据。使用 Cox 比例风险模型进行生存分析。在 5000 名 HCV/HIV 合并感染的个体中，1671 名（33.4%）有预处理贫血。在长达 7 年的随访期内（19500 人年），贫血患者的死亡率明显高于无贫血患者[分别为 144.2（95%CI：134.5-154.7）和 47.5（44.0-51.2）/1000 人年]。在贫血患者中，HCV 治疗与死亡率显著降低相关[分别为 66.6（44.3-100.2）和 149.6（139.2-160.5）/1000 人年，治疗与未治疗相比]。在考虑多种合并症的影响后，治疗仍与显著的生存获益相关（风险比：0.34，95%CI：0.21-0.62）。这些数据表明，与无贫血患者相比，预处理贫血的 HCV/HIV 合并感染个体的死亡率明显更高。在该组中，HCV 治疗与显著的生存获益相关。需要进一步的研究来确定改善该组 HCV 治疗率的策略。
