丙型肝炎病毒感染患者实现持续病毒学应答后，合并感染人类免疫缺陷病毒对死亡率无影响。

No Impact of HIV Coinfection on Mortality in Patients With Hepatitis C Virus Infection After Sustained Virological Response.

作者信息

Martín-Carmona Jesica, Corma-Gómez Anaïs, Téllez Francisco, Arenga-Barrios Dolores, Serrano-Fuentes Miriam, Morano Luis, Corona-Mata Diana, Navarrete Lorite Miguel Nicolás, Vera-Méndez Francisco Jesús, Alados Juan Carlos, Palacios Rosario, de Los Santos Ignacio, Geijo Paloma, Imaz Arkaitz, Merino Dolores, Reus-Bañuls Sergio Javier, Galindo Maria Jose, López-Ruz Miguel Ángel, Galera Carlos, Pineda Juan A, Macías Juan

机构信息

Cinical Virology and STIs Group, Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain.

Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Seville, Spain.

出版信息

Clin Infect Dis. 2025 Apr 30;80(4):835-841. doi: 10.1093/cid/ciae473.

DOI:10.1093/cid/ciae473

PMID:39293030

Abstract

BACKGROUND

In patients with hepatitis C virus (HCV) chronic infection and advanced liver disease, the impact of human immunodeficiency virus (HIV) coinfection on the clinical outcome after sustained virological response (SVR) has not been sufficiently clarified. The aim of this study was to compare the mortality after SVR of patients bearing HCV chronic infection and advanced liver fibrosis, with and without HIV coinfection after a prolonged follow-up.

METHODS

This was a prospective multicenter cohort study including individuals with HIV/HCV coinfection and patients with HCV monoinfection from Spain, fulfilling (1) liver stiffness (LS) ≥9.5 kPa before treatment, (2) SVR with a direct-acting antiviral-based regimen, and (3) LS measurement available at SVR. The main outcome was overall survival. Mortality attributable to liver disease and nonhepatic causes was also assessed.

RESULTS

A total of 1118 patients were included, of whom 676 (60.5%) had HIV. The median (Q1-Q3) follow-up was 76 (57-83) months. After SVR, 46 (10%) HCV-monoinfected and 74 (11%) HIV/HCV-coinfected patients died. The overall mortality rate (95% CI) was 1.9 (1.6-2.2) per 100 person-years, 1.9 (1.4-2.5) per 100 person-years in patients with HCV monoinfection, and 1.8 (1.6-2.3) per 100 person-years in people with HIV. In the multivariable analysis, HIV coinfection was not associated with shorter survival (hazard ratio, .98; 95% CI, .61-1.58; P = .939).

CONCLUSIONS

In patients with HCV chronic infection and advanced fibrosis, HIV coinfection does not reduce the overall survival after SVR.

CLINICAL TRIALS REGISTRATION

Clinicaltrials.gov (NCT04460157).

摘要

背景

在丙型肝炎病毒（HCV）慢性感染和晚期肝病患者中，人类免疫缺陷病毒（HIV）合并感染对持续病毒学应答（SVR）后临床结局的影响尚未得到充分阐明。本研究的目的是比较经过长期随访后，合并或未合并HIV感染的HCV慢性感染和晚期肝纤维化患者SVR后的死亡率。

方法

这是一项前瞻性多中心队列研究，纳入了来自西班牙的HIV/HCV合并感染个体和HCV单一感染患者，这些患者满足以下条件：（1）治疗前肝脏硬度（LS）≥9.5 kPa；（2）采用基于直接作用抗病毒药物的方案实现SVR；（3）在SVR时可进行LS测量。主要结局是总生存期。还评估了肝病和非肝脏原因导致的死亡率。

结果

共纳入1118例患者，其中676例（60.5%）合并HIV感染。中位（四分位间距）随访时间为76（57 - 83）个月。SVR后，46例（10%）HCV单一感染患者和74例（11%）HIV/HCV合并感染患者死亡。总死亡率（95%CI）为每100人年1.9（1.6 - 2.2）例，HCV单一感染患者为每100人年1.9（1.4 - 2.5）例，HIV感染患者为每100人年1.8（1.6 - 2.3）例。在多变量分析中，HIV合并感染与生存期缩短无关（风险比，0.98；95%CI，0.61 - 1.58；P = 0.939）。