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直接抗病毒药物时代:评估HIV/HCV合并感染与HIV感染个体的患者特征、临床影响及合并症的出现情况。

The Era of DAAs: Assessing the Patients' Characteristics, Clinical Impact, and Emergence of Comorbidities in HIV/HCV-Coinfected versus HIV-Infected Individuals.

作者信息

Álvarez-Álvarez Beatriz, Prieto-Pérez Laura, de la Cuadra-Grande Alberto, Casado Miguel Ángel, Cabello Úbeda Alfonso, Al-Hayani Aws W, Carrillo Acosta Irene, Mahillo-Fernández Ignacio, Górgolas Hernández-Mora Miguel, Benito Jose M, Rallón Norma

机构信息

Division of Infectious Diseases, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain.

Pharmacoeconomics & Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4, Letter I, Pozuelo de Alarcón, 28224 Madrid, Spain.

出版信息

J Clin Med. 2024 Jul 4;13(13):3936. doi: 10.3390/jcm13133936.

Abstract

To determine whether HIV-infected individuals versus individuals with HIV/HCV coinfection, in the era of interferon-free therapies, exhibit an increased incidence of comorbidities and non-AIDS-related events. A retrospective analysis was conducted by collecting data from clinical records of Spanish patients at a tertiary hospital involving HIV/HCV-coinfected and HIV-infected patients, all with effectively controlled HIV. Coinfected patients underwent HCV clearance using direct-acting antivirals (DAAs) and had no history of interferon treatment. The incidences of hypertension, diabetes mellitus, cardiovascular disease, kidney disease, liver disease, non-AIDS cancer, and death were compared between the groups. Multivariate adjustments for all factors potentially impacting outcomes were used to assess the risk of clinical event onset. Propensity score (PS) analyses were also conducted to support the multivariate model results. Data were available from 229 HIV/HCV-coinfected patients and 229 HIV-infected patients. Both cohorts were comparable in terms of age, gender distribution, follow-up, and HIV-related characteristics. Multivariate models and PS showed that previous exposure to HCV was not associated with the onset of any clinical events studied. Significant differences between HIV/HCV-coinfected and HIV-infected were not found for survival according to the log-rank test ( = 0.402). Successful HCV elimination using DAAs improved the outlook regarding comorbidities and survival across HIV/HCV-coinfected cohorts. Early HCV detection and DAA therapy could enhance clinical results. These findings provide an optimistic perspective for those living with HIV/HCV coinfection and underscore the importance of continuing efforts toward early detection and DAA treatment initiation.

摘要

为确定在无干扰素治疗时代,与单纯感染HIV的个体相比,HIV/HCV合并感染的个体是否具有更高的合并症发病率和非艾滋病相关事件发生率。通过收集一家三级医院西班牙患者的临床记录数据进行回顾性分析,这些患者包括HIV/HCV合并感染和单纯感染HIV的患者,所有患者的HIV均得到有效控制。合并感染患者使用直接抗病毒药物(DAA)清除HCV,且无干扰素治疗史。比较两组之间高血压、糖尿病、心血管疾病、肾脏疾病、肝脏疾病、非艾滋病相关癌症和死亡的发生率。对所有可能影响结果的因素进行多变量调整,以评估临床事件发生的风险。还进行了倾向评分(PS)分析以支持多变量模型结果。有229例HIV/HCV合并感染患者和229例HIV感染患者的数据可用。两组在年龄、性别分布、随访和HIV相关特征方面具有可比性。多变量模型和PS显示,既往HCV暴露与所研究的任何临床事件的发生均无关。根据对数秩检验,HIV/HCV合并感染组和HIV感染组在生存率方面未发现显著差异(P = 0.402)。使用DAA成功清除HCV改善了HIV/HCV合并感染队列中合并症和生存的前景。早期HCV检测和DAA治疗可改善临床结果。这些发现为HIV/HCV合并感染患者提供了乐观的前景,并强调了持续努力进行早期检测和启动DAA治疗的重要性。

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