Lower Liver-related Mortality in African American Women Co-infected with HIV and HCV
S Monika1, P Bacchetti1, A French2, M Nowicki3, M Glesby4, G Sharp5, S Gange6, H Minkoff7, M Plankey8, Marion Peters*1, and Women’s Interagency HIV Study
1Univ of California, San Francisco, US; 2CORE Ctr, Stroger Hosp of Cook County, Chicago, IL, US; 3Univ of Southern California, Keck Sch of Med, Los Angeles, US; 4Weill Cornell Med Coll, New York, NY, US; 5DAIDS, NIAID, NIH, Bethesda, MD, US; 6Johns Hopkins Univ Bloomberg Sch of Publ Hlth, Baltimore, MD, US; 7State Univ of New York Downstate Med Ctr, Brooklyn, US; and 8Georgetown Univ Sch of Med, Washington, DC, US
Background: In both HIV+ and HIV– individuals, racial and ethnic differences in the natural history of hepatitis C virus (HCV) have been reported. African Americans have lower spontaneous HCV clearance than Caucasians, yet slower rates of liver fibrosis. It is not clear how these differences in the natural history of hepatitis C affect mortality. In a large cohort of HIV/HCV-co-infected women, we determined whether race and ethnicity affect all-cause and liver-related mortality.
Methods: We studied women with HIV and chronic HCV who were followed in the multi-center, NIH-funded, Women’s Interagency HIV Study (WIHS). The eligible cohort (n = 794) included 140 Caucasians, 159 Hispanics, and 495 African Americans. All included women were HCV antibody+ and HIV antibody+, and had detectable HCV viral load at WIHS study entry. Follow-up medical health history and laboratory measures were obtained at semi-annual study visits. Deaths were ascertained continuously using active and passive (NDI+) methods; causes were determined by death certificate. Cox proportional hazards models were used to assess all-cause and liver-related mortality.
Results: Women were followed for ≤16 years, with an average follow-up of 8.4 years. During this time, there were 449 deaths, 47 of which could be attributed to liver disease. All-cause mortality was similar by race and ethnicity. African American co-infected women had significantly lower age-adjusted liver-related mortality than both Caucasians (HR 0.46, 95%CI 0.22 to 0.98, p = 0.045) and Hispanics (HR 0.45, 0.22 to 0.91, p = 0.028). These differences remained when adjusted for HIV status (HR 0.39, 0.18 to 0.84, p = 0.016; and HR 0.38, 0.19 to 0.79, p = 0.01), substance abuse (HR 0.44, 0.21 to 0.95, p = 0.038; and HR 0.46, 0.22 to 0.94, p = 0.033), cardiac risk factors (HR 0.46, 0.21 to 1.0, p = 0.049; and 0.43, 0.21 to 0.90, p = 0.026), compared to Caucasian and Hispanic women, respectively.
Conclusions: Although all-cause mortality was similar among African Americans, Caucasians, and Hispanics, important racial/ethnic differences were observed for liver-related mortality, with significantly lower liver-related mortality among African Americans than Caucasian and Hispanic co-infected women.