@article{c59d8f5a3d99499fa5bad8ada2081337,
title = "The Effects of Hepatitis C Infection and Treatment on All-cause Mortality Among People Living With Human Immunodeficiency Virus",
abstract = "Background Persons living with human immunodeficiency virus (HIV; PLwH) are commonly co-infected with hepatitis C virus (HCV). Most co-infected individuals can achieve a sustained HCV virologic response after treatment with direct-acting antivirals (DAA). However, the effect of HCV co-infection and DAA treatment on mortality after initiating antiretroviral therapy (ART) is unknown for PLwH. Methods We analyzed data from the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study. Participants included those who had prevalent HIV or seroconverted during follow-up; all were antiretroviral-naive and acquired immunodeficiency syndrome (AIDS)-free prior to their first visit after 1 October 1994. The follow-up lasted 10 years or until 30 September 2015. We used parametric g-computation to estimate the effects of HCV infection and DAA treatment on mortality had participants initiated ART at study entry. Results Of the 3056 eligible participants, 58% were female and 18% had HCV. The estimated 10-year all-cause mortality risk in the scenario in which no PLwH had HCV was 10.4% (95% confidence interval [CI] 6.0-18.0%). The 10-year mortality risk difference for HCV infection was 4.3% (95% CI 0.4-8.9%) and the risk ratio was 1.4 (95% CI 1.0-1.9). The risk difference for DAA treatment was -3.8% (95% CI -9.2-0.9%) and the risk ratio was 0.8 (95% CI 0.6-1.1). Conclusions HCV co-infection remains an important risk factor for mortality among PLwH after initiating ART according to modern guidelines, and DAAs are effective at reducing mortality in this population. HCV prevention and treatment interventions should be prioritized to reduce mortality among PLwH.",
keywords = "antiretroviral therapy, direct-acting antivirals, hepatitis C virus, human immunodeficiency virus",
author = "Alexander Breskin and Daniel Westreich and Cole, {Stephen R.} and Hudgens, {Michael G.} and Hurt, {Christopher B.} and Seaberg, {Eric C.} and Thio, {Chloe L.} and Tien, {Phyllis C.} and Adimora, {Adaora A.}",
note = "Funding Information: Financial support. This work was supported by the National Institute of Allergy and Infectious Disease (grant numbers R01 AI100654 to S. R. C., P30 AI50410 to M. G. H., U01 AI35042 to C. L. T., and K24 AI108516 to P. C. T.) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (DP2 HD084070 to D. W. and A. B.). Funding Information: The Multicenter AIDS Cohort Study (MACS) is funded primarily by the National Institute of Allergy and Infectious Diseases, with additional co-funding from the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute of Mental Health (grant numbers U01 AI35042 to the Baltimore team, U01 AI35039 to the Chicago team, U01 AI35040 to the Los Angeles team, U01 AI35041 to the Pittsburgh team, and UM1 AI35043 to the Data Coordinating Center). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute and the National Institute on Deafness and Communication Disorders. MACS data collection is also supported by grant UL1 TR001079 (Johns Hopkins University Institute for Clinical and Translational Research) from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. Funding Information: The Women{\textquoteright}s Interagency HIV Study (WIHS) is funded primarily by the National Institute of Allergy and Infectious Diseases, with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Mental Health (grant numbers U01 AI103401 to the University of Alabama School of Medicine team, U01 AI103408 to the Atlanta team, U01 AI035004 to the Bronx team, U01 AI031834 to the Brooklyn team, U01 AI034993 to the Chicago team, U01 AI034994 to the Metropolitan Washington team, U01 AI103397 to the Miami team, U01 AI103390 to the University of North Carolina at Chapel Hill team, U01 AI034989 to the team at the Connie Wofsy Women{\textquoteright}s HIV Study in Northern California, U01 AI042590 to the WIHS Data Management and Analysis Center, and U01 HD032632 to the Southern California team). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Deafness and other Communication Disorders, and the NIH Office of Research on Women{\textquoteright}s Health. WIHS data collection is also supported by grant numbers UL1 TR000004 (to the University of California, San Francisco, Clinical & Translational Science Institute [CTSA]), UL1 TR000454 (to the Atlanta CTSA), and P30 AI050410 (to the University of North Carolina at Chapel Hill Center for AIDS Research). Funding Information: from Gilead, is on a Merck advisory board, and received consultation fees from Viiv. C. B. H. supervised a clinical trial under an institutional contract between the University of North Carolina at Chapel Hill and AbbVie. P. C. T. is conducting investigator-initiated research sponsored by Merck and received a grant from Theratechnologies. C. L. T. has received research funding paid to her institution from Gilead Sciences. D. W. reports grants from the National Institutes of Health during the conduct of the study and consulting with Sanofi-Pasteur unrelated to the present work, the human immunodeficiency virus, or the hepatitis C virus. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Publisher Copyright: {\textcopyright} The Author(s) 2018.",
year = "2019",
month = mar,
day = "19",
doi = "10.1093/cid/ciy588",
language = "English (US)",
volume = "68",
pages = "1152--1159",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "7",
}