[956] SURVIVAL OF PATIENTS INFECTED WITH HIV AND HCV IN THE ERA OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] SURVIVAL OF PATIENTS INFECTED WITH HIV AND HCV IN THE ERA OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

[AUTHOR(S):] N Voirin¹, C Trepo², P Miailhes², JL Touraine³, C Chidiac⁴, D Peyramond⁴, JM Livrozet³, J Ritter³, P Chevallier³, J Fabry¹ and P Vanhems¹
¹Université Claude Bernard and INSERM U271, Lyon, France; ²Hôtel-Dieu and INSERM U271, Lyon, France; ³Hôpital Edouard Herriot, Lyon, France; and ⁴Hôpital de la Croix Rousse, Lyon, France

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 956
Antiviral Therapy 2003; 8(Suppl. 1):S454

[ABSTRACT:] Co-infection with hepatitis C virus (HCV) has been associated with an increased mortality in HIV-infected patients in the era of highly active antiretroviral therapy (HAART) (Greub et al., 2000), especially for intravenous drug users (IDU), suggesting that HCV infection could affect the response to HAART. A survival analysis was performed according to HCV infection and intravenous drug use for patients included in the Lyon section of the French Hospital Database of HIV positive patients between 1992 and 2002. Patients were stratified in 3 groups (G): HCV./IDU. (G1), HCV+/IDU. (G2) and HCV+/IDU+ (G3). The analysis was done for 2 calendar periods according to the date of inclusion in the cohort: the pre-HAART era (<1996) and the HAART era (≥1996) using a Cox model for each period adjusted for age, gender and baseline CD4 cells count. Out of a total of 2,710 patients (2,185 men, 81%) with a median age at inclusion of 34 years old, 2,253 (83%) were HCV–/IDU–, 228 (8%) were HCV+/IDU–, 241 (9%) were HCV+/IDU+; 1,240 (46%) were included in the pre-HAART era and 1,470 (54%) in the HAART era. During the pre-HAART era, the mortality rate was 25%, 23%, 23% at 3 years and 32%, 33%, 33% at 5 years for G1, G2, G3, respectively (log rank test, P=0.96). During the HAART era, the mortality rate was 5%, 4%, 16% at 3 years and 7%, 10%, 23% at 5 years for G1, G2, G3, respectively (log rank test, P<0.001). The adjusted hazard ratio of progression to death was 1.05 (95%CI 0.75–1.47, P=0.75) for G2 and 0.90 (95% CI 0.65–1.25, P=0.52) for G3, compared to G1 in the pre-HAART era. The adjusted hazard ratio of progression to death was 0.76 (95% CI 0.28–2.08, P=0.59) for G2 and 2.92 (95% CI 1.63–5.23, P<0.001) for G3, compared to G1 in the HAART era. These results confirm that HCV and intravenous drug use are predictors of survival in patients in the post-HAART era, suggesting that the response to HAART was not optimal in HCV+/IDU+ patients and emphasize the need to improve the management of these patients. Adherence to therapy and maybe specific virological or immunological pathogenic mechanisms due to HAART in HIV/HCV co-infected individuals might be explored further.

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