Role of Hepatitis C Coinfection in HIV Prognosis: Data from the HIV Atlanta VA Cohort Study (HAVACS) Público

Abstract

Background: This study compared survival and progression to AIDS among patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) to that of patients infected with HIV alone.

Methods: This analysis used data from the prospective HIV Atlanta Veterans Affairs Cohort Study (HAVACS), which includes HIV-positive patients who received care at the Infectious Disease Clinic at the Atlanta Veterans Affairs (VA) Medical Center between January 1997 to April 2014, (n= 3,325). Kaplan Meier curves and adjusted proportional hazard (PH) regression models compared survival of HCV/HIV coinfected and HIV monoinfected patients for the following time-to-event outcomes: 1) from HIV-diagnosis to death, 2) from HIV diagnosis to AIDS diagnosis, and 3) from AIDS diagnosis to death. The analysis for the first outcome was conducted separately for patients with low (< 200 cells/mm³) and high CD4 count (≥200 cells/mm³) due to a statistical interaction between CD4 count and HCV coinfection.

Results: A total of 3,236 patients from the HAVACS dataset were eligible for inclusion in this study, and HCV coinfection was present in 21% (n=693) of participants. Twenty-seven percent (n=890) of all study participants died during the follow-up period. Adjusted PH models showed HCV coinfection was not associated decreased survival among HIV patients with low CD4 count (hazard ratio [HR]=0.95, 95% confidence interval [CI]: 0.76-1.19); however, patients with HCV experienced shorter survival time after HIV diagnosis in the group with higher CD4 counts (HR=1.66, 95% CI: 1.27-2.17). HCV coinfection was also associated with higher rates of death among AIDS patients (HR=1.33; 95% 1.03-1.72). There was no significant difference in time between diagnoses of HIV and AIDS by HCV coinfection status (HR=0.87, 95% CI: 0.72-1.10).

Conclusion: HCV coinfection among HIV-positive individuals in the HAART era is associated with decreased length of survival after HIV diagnosis in patients with higher CD4 counts (≥200 cells/mm³). HCV infection is also associated with shorter survival time after AIDS diagnosis. HCV infection does not appear to significantly impact the length of time between HIV diagnosis and progression to AIDS.

Table of Contents

Chapter I: Literature Review, pages 1-8

Chapter II: Manuscript

Introduction, pages 9-11

Methods, pages 11-13

Results, pages 13-16

Discussion, pages 16-19

Conclusion, pages 19-20

References, pages 21-23

Tables and Figures, 24-32

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Palavra-chave	human immunodeficiency virus hepatitis C coinfection mortality
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University
Committee Members	Umpierrez, Guillermo, Emory University

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