Abstract 569 - Hepatitis C (HCV) Co-Infection Is Associated with Increased Morbidity and Mortality Among HIV-Infected Patients.

569 Hepatitis C (HCV) Co-Infection Is Associated with Increased Morbidity and Mortality Among HIV-Infected Patients.

M. B. Klein*, R. G. Lalonde, and S. Suissa.
McGill Univ. Hlth. Ctr., Royal Victoria Hosp., Montreal, Quebec, Canada.

Background:There is an increasing number of patients with dual HIV and HCV infections. The introduction of highly active antiretroviral therapy (HAART) has led to a dramatic reduction in the morbidity and mortality associated with HIV infection overall, but it remains unclear if HCV co-infected patients have fully benefited.

Methods:Using a clinical database, we compared all patients testing HCV seropositive (HCV⁺) to those testing HCV negative (HCV-) at a tertiary care HIV clinic from Jan. 1996 through June 2000. The primary outcomes studied were development of AIDS-defining illnesses (OI), deaths and hospitalisations. The cumulative incidences of outcomes were calculated using the Kaplan-Meier survival method. Cox proportional hazards models were used to compare rates adjusted for relevant covariates.

Results:78 HCV⁺patients were compared to 104 HCV^-. Baseline demographic characteristics were similar, with a mean age of 38 years, 70% male. Significantly more HCV⁺had injection drug use as a risk factor for HIV infection (73% vs. 4%). Baseline CD4 cell count was 314 and 303 cells/ml; plasma HIV viral load was 4.17 and 3.69 log₁₀copies/ml in HCV⁺and HCV^-, respectively. Fewer HCV⁺were receiving HAART at baseline: 18 (23%) vs. 36 (35%). The rate of OI was 9.77 vs 7.91/100 p-y; deaths: 6.67 vs. 2.27/100 p-y; and hospitalisations: 15.03 vs 6.79/100 p-y in HCV⁺and HCV^-

respectively. HCV⁺was associated with a faster progression to death (log rank p = 0.04). The relative risk of death was 11.7 (p = 0.05) and of hospitalisation was 2.5 (p = 0.03) after adjustment for baseline and follow-up measures of CD4 cell count, HIV viral load, duration of HIV infection, and use of HAART. HCV⁺patients were less likely to be receiving HAART at any period during follow-up.

Conclusions:HCV co-infection is associated with a significant increase in hospitalisations and mortality among HIV-infected patients. This may be explained in part by lower use of HAART (drug intolerance and/or poor access to medications) but also by increased co-morbid factors associated with injection drug use.