Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP.
AP-HP, Public Health Unit, Saint-Antoine Hospital.
AIDS. 2023 Jul 1;37(8):1297-1306. doi: 10.1097/QAD.0000000000003569. Epub 2023 Apr 5.
It is unknown whether hepatitis C virus (HCV)-cured people with HIV (PWH) without cirrhosis reached the same mortality risk as HCV-uninfected PWH. We aimed to compare mortality in PWH cured of HCV by direct-acting antivirals (DAAs) to mortality in individuals with HIV monoinfection.
Nationwide hospital cohort.
HIV-controlled participants without cirrhosis and HCV-cured by DAAs started between September 2013 and September 2020, were matched on age (±5 years), sex, HIV transmission group, AIDS status, and body mass index (BMI) (±1 kg/m 2 ) to up to 10 participants with a virally suppressed HIV monoinfection followed at the time of HCV cure ±6 months. Poisson regression models with robust variance estimates were used to compare mortality in both groups after adjusting for confounders.
The analysis included 3961 HCV-cured PWH (G1) and 33 872 HCV-uninfected PWH (G2). Median follow-up was 3.7 years in G1 [interquartile range (IQR): 2.0-4.6], and 3.3 years (IQR: 1.7-4.4) in G2. Median age was 52.0 years (IQR: 47.0-56.0), and 29 116 (77.0%) were men. There were 150 deaths in G1 [adjusted incidence rate (aIR): 12.2/1000 person-years] and 509 (aIR: 6.3/1000 person-years) in G2, with an incidence rate ratio (IRR): 1.9 [95% confidence interval (CI), 1.4-2.7]. The risk remained elevated 12 months post HCV cure (IRR: 2.4 [95% CI, 1.6-3.5]). Non-AIDS/non-liver-related malignancy was the most common cause of death in G1 (28 deaths).
Despite HCV cure and HIV viral suppression, after controlling on factors related to mortality, DAA-cured PWH without cirrhosis remain at higher risk of all-cause mortality than people with HIV monoinfection. A better understanding of the determinants of mortality is needed in this population.
目前尚不清楚丙型肝炎病毒（HCV）治愈且无肝硬化的人类免疫缺陷病毒（HIV）感染者（PWH）的死亡率是否与 HCV 未感染者相同。我们旨在比较经直接作用抗病毒药物（DAA）治愈 HCV 的 PWH 与 HIV 单一感染个体的死亡率。
全国性医院队列研究。
纳入 2013 年 9 月至 2020 年 9 月期间开始接受 DAA 治疗且无肝硬化且 HCV 已治愈的 HIV 得到控制的参与者，并按年龄（±5 岁）、性别、HIV 传播途径、艾滋病状态和体重指数（BMI）（±1 kg/m 2 ）与同时接受 HCV 治疗时 HIV 抑制良好的 HIV 单一感染患者进行匹配，随访时间为 HCV 治愈±6 个月（10 例）。采用泊松回归模型，对混杂因素进行调整后，比较两组的死亡率。
本分析纳入了 3961 例 HCV 治愈的 PWH（G1 组）和 33872 例 HCV 未感染的 PWH（G2 组）。G1 组的中位随访时间为 3.7 年（IQR：2.0-4.6），G2 组为 3.3 年（IQR：1.7-4.4）。中位年龄为 52.0 岁（IQR：47.0-56.0），29116 例（77.0%）为男性。G1 组有 150 例死亡（调整后的发病率（aIR）：12.2/1000 人年），G2 组有 509 例（aIR：6.3/1000 人年），发病率比（IRR）为 1.9（95%置信区间（CI）：1.4-2.7）。HCV 治愈后 12 个月时，风险仍升高（IRR：2.4[95%CI，1.6-3.5]）。非艾滋病/非肝脏相关恶性肿瘤是 G1 组死亡的最常见原因（28 例死亡）。
尽管 HCV 已治愈且 HIV 已得到抑制，但在控制与死亡率相关的因素后，无肝硬化的 DAA 治愈的 PWH 的全因死亡率仍高于 HIV 单一感染患者。需要更好地了解该人群中死亡率的决定因素。
