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Risk of Death & Grade 4 events in HCV/HIV Coinfected
Report from Jules Levin
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The risk of life threatening events and death have not been precisely
characterized for patients coinfected with hepatitis b and/or hepatitis C
receiving HAART.
Ron Reisler, from DAIDS at the NIH, and the CPCRA analyzed 2027 patients
enrolled in 3 large CPCRA studies between 5/97-11/01. Data collection from
the 3 studies were the same.
Average age was 40; CD4 was 280; 17% female; 53% were African-American. 55%
were AA among HCV+ patients; 49% with HBV were African-American; but, only
40% who were HCV-negative were African-American. 60% of the HCV+ patients
were IVDUs or former users. 25% had prior AIDS. 74% of HCV+ patients were
treatment-naïve compared to 62% with HBV and 62% of hepatitis negative
patients, suggesting perhaps coinfected patients do not receive treatment as
often.
- 5.7% had hepatitis B (HepBSAg+)
- 17.4% had HCV (HCB Ab+)
- cumulative death rate was higher among hepatitis positive patients compared
to patients without hepatitis (7.1% death rate vs 5.3% [p=0.01] after 30
months of followup). After 18 months of followup the difference was more
pronounced 6.2% for hepatitis patients vs 2.9% for patients without hepatitis
- cumulative incidence of grade 4 liver events was higher in patients with
hepatitis 7.4% vs 3.0% (p=0.0001) after 30 months of followup
- cumulative incidence of any grade 4 event was higher among patients with
hepatitis than patients without hepatitis (28.5% vs 21.5% [p=0.0006])
The authors found liver related events were the most common grade 4 events
(lab values and/or clinical events). Hepatitis B/C coinfection was the only
significant predictor of any grade 4 event. Potential contributing factors to
these results are a patient history of grade 4 events prior to study
enrollment, IVDU or alcohol use, sicioeconomic status, co-morbid conditions,
concomitant medications
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