Erqou Sebhat, Mohanty Arpan, Murtaza Kasi Pashtoon, Butt Adeel A
Department of Medicine, Division of Hospital Medicine, Weill Cornell Medical College, 525 East 68th Street, P.O. Box 130, New York, NY 10065, USA ; VA Pittsburgh Health Care System, Pittsburgh, PA 15213, USA.
Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
ISRN Gastroenterol. 2014 Apr 7;2014:764540. doi: 10.1155/2014/764540. eCollection 2014.
Background. Understanding the predictors of mortality in individuals with human immunodeficiency virus and hepatitis C virus (HIV/HCV) coinfection can be useful in management of these patients. Methods. We used the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) for these analyses. Multivariate Cox-regression models were used to determine predictors of mortality. Results. Among 8,039 HIV infected veterans, 5251 (65.3%) had HCV coinfection. The all-cause mortality rate was 74.1 (70.4-77.9) per 1000 person-years (PY) among veterans with HIV/HCV coinfection and 39.8 (36.3-43.6) per 1000 PY for veterans with HIV monoinfection. The multivariable adjusted hazard ratio (95% confidence interval) of all-cause mortality for HCV infection was 1.58 (1.36-1.84). Positive predictors of mortality included decompensated liver disease (2.33 (1.98-2.74)), coronary artery disease (1.74 (1.32-2.28)), chronic kidney disease (1.62 (1.36-1.92)), and anemia (1.58 (1.31-1.89)). Factors associated with reduced mortality included HCV treatment (0.41 (0.27-0.63)) and higher CD4 count (0.90 (0.87-0.93) per 100 cells/ μ L higher count). Data were insufficient to make informative analyses of the role of HCV virologic response. Conclusion. HCV coinfection was associated with substantial increased risk of mortality among HIV infected veterans. HCV treatment was associated with significantly lower risk of mortality.
背景。了解人类免疫缺陷病毒和丙型肝炎病毒（HIV/HCV）合并感染患者的死亡预测因素有助于这些患者的管理。方法。我们使用电子检索的丙型肝炎病毒感染退伍军人队列（ERCHIVES）进行这些分析。采用多变量Cox回归模型确定死亡预测因素。结果。在8039名感染HIV的退伍军人中，5251名（65.3%）合并感染HCV。HIV/HCV合并感染退伍军人的全因死亡率为每1000人年74.1（70.4 - 77.9），HIV单一感染退伍军人的全因死亡率为每1000人年39.8（36.3 - 43.6）。HCV感染的全因死亡率多变量调整风险比（95%置信区间）为1.58（1.36 - 1.84）。死亡的阳性预测因素包括失代偿性肝病（2.33（1.98 - 2.74））、冠状动脉疾病（1.74（1.32 - 2.28））、慢性肾病（1.62（1.36 - 1.92））和贫血（1.58（1.31 - 1.89））。与死亡率降低相关的因素包括HCV治疗（0.41（0.27 - 0.63））和较高的CD4细胞计数（每100个细胞/μL计数每增加，风险比为0.90（0.87 - 0.93）））。数据不足以对HCV病毒学应答的作用进行有意义的分析。结论。HCV合并感染与HIV感染退伍军人的死亡风险大幅增加相关。HCV治疗与显著降低的死亡风险相关。
