HCV Partly Explains the Increased Mortality among HIV-Infected Individuals with Injection Drug Use as an HIV Transmission Factor
HIV-infected patients with injection drug use (IDU) as a transmission factor have increased mortality even with access to antiretroviral treatment (ART). The purpose of this study was to determine whether the association between IDU as a transmission factor and mortality in this population was explained by increased prevalence of hepatitis C infection (HCV). The authors analyzed data from 16 centers in the Antiretroviral Therapy Cohort Collaboration, an international collaboration of cohort studies examining HIV-infected individuals initiating ART. Of 32,703 patients, 3374 reported IDU, 4630 had evidence of HCV infection, and 1116 died.
- There was an increased risk of mortality among patients reporting IDU as a transmission factor compared with those not (adjusted hazard ratio [aHR], 2.71), and among patients with HCV compared with those without (aHR, 2.65).
- The effect of IDU was attenuated after adjustment for HCV (aHR, 1.57), while the converse (attenuation of HCV effect by IDU) was less substantial (aHR, 2.04).
- CNS and respiratory mortality was less attenuated and violent mortality was not attenuated with adjustment for HCV.
Comments:
HCV infection explains some of the association between history of IDU transmission risk and mortality in an analysis of a large cohort of HIV-infected individuals initiating ART. This study does not include measures of active IDU and does not include a measure of overdose-specific mortality. This is a timely discussion as the landscape of HCV treatment is shifting to more effective, and costly, direct-acting antivirals that may have the potential to impact the observed mortality difference.
Jeanette M. Tetrault, MD
Reference:
May MT, Justice AC, Birnie K, et al. Injection drug use and hepatitis C as risk factors for mortality in HIV-infected individuals: the Antiretroviral Therapy Cohort Collaboration. J Acquir Immune Defic Syndr. 2015;69(3):348–354.