Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals: The Antiretroviral Therapy Cohort Collaboration.
May MT et al.
J Acquir Immune Defic Syndr. 2015 Jul 1;69(3):348-54.

Within the large Antiretroviral Therapy Cohort Collaboration an analyses was performed which aimed at explaining the survival differences in HIV-infected individuals with a history of transmission through injection drug use (IDU) compared to other HIV affected key populations. Adults who started antiretroviral therapy between 2000 and 2009 in 16 European and North American cohorts with >70% complete data on HCV status were followed for 3 years. Mortality hazard ratios were estimated unadjusted and adjusted (for age, sex, baseline CD4 count and HIV-1 RNA, AIDS diagnosis before antiretroviral therapy, and stratified by cohort) for IDU (versus non-IDU) and for HCV-infected (versus HCV uninfected). An impressive 32,703 patients entered the analyses. Overall, 3374 (10%) were IDU; 4630 (14%) were HCV positive; 1116 (3.4%) died. Mortality was higher in IDU compared with non-IDU [adjusted HR 2.71; 95% confidence interval (CI): 2.32 to 3.16] and in HCV+ compared with HCV- (adjusted HR 2.65; 95% CI: 2.31 to 3.04). The effect of IDU was substantially attenuated (adjusted HR 1.57; 95% CI: 1.27 to 1.94) after adjustment for HCV, while attenuation of the effect of HCV was less substantial (adjusted HR 2.04; 95% CI: 1.68 to 2.47) after adjustment for IDU. Both IDU and HCV were strongly associated with liver-related mortality (adjusted HR 10.89; 95% CI: 6.47 to 18.3 for IDU and adjusted HR 14.0; 95% CI: 8.05 to 24.5 for HCV) with greater attenuation of the effect of IDU (adjusted HR 2.43; 95% CI: 1.24 to 4.78) than for HCV (adjusted HR 7.97; 95% CI: 3.83 to 16.6). Rates of CNS, respiratory and violent deaths remained elevated in IDU after adjustment for HCV.

In conclusion, these results underline the high access risk of dying from liver disease in the HIV/HCV coinfected IDU patient population. With the rising availability of IFN-free DAA-based curative HCV therapies, HCV treatment in this particular patient group needs to be prioritized and made accessible everywhere. CONCLUSIONS: A substantial proportion of the excess mortality in HIV-infected IDU is explained by HCV coinfection. These findings underscore the potential impact on mortality of new treatments for HCV in HIV-infected people.

Conclusion

A substantial proportion of the excess mortality in HIV-infected IDU is explained by HCV coinfection. These findings underscore the potential impact on mortality of new treatments for HCV in HIV-infected people.