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Risk of Hepatitis-Related Mortality Increased Among Hepatitis C Virus/HIV-Coinfected Drug Users Compared With Drug Users Infected Only With Hepatitis C Virus: A 20-Year Prospective Study

Smit, Colette PhD*; van den Berg, Charlotte MD*†‡; Geskus, Ronald PhD; Berkhout, Ben PhD†‡; Coutinho, Roel MD, PhD‡∥; Prins, Maria PhD*‡¶

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2008 - Volume 47 - Issue 2 - p 221-225
doi: 10.1097/QAI.0b013e31815d2f59
Epidemiology and Social Science

Background: Progression of liver-related disease is accelerated in individuals coinfected with HIV and hepatitis C virus (HCV). Because the life expectancy of HIV-infected drug users (DUs) improved after the widespread use of highly active antiretroviral therapy (HAART), HCV-related death is likely to become more important. To disentangle the effects of HCV and HIV, we compared the overall and cause-specific mortality between HCV/HIV-infected DUs and HCV-infected DUs and DUs without HCV or HIV, followed up between 1985 and 2006.

Methods: A total of 1295 participants in the Amsterdam Cohort Study were included. Cause-specific hazard ratios (CHRs) were estimated for the eras before (<1997) and since HAART (≥1997) within and among serologic groups.

Results: The risk of dying decreased for most causes of death ≥1997; this decrease was not the same for the different serologic groups. Among HCV/HIV-coinfected DUs, the risk of hepatitis/liver-related death did not substantially change over time (CHR = 0.87, 95% confidence interval [CI]: 0.21 to 3.58), whereas the risk of AIDS-related mortality decreased. Compared with DUs solely infected with HCV, HCV/HIV-coinfected DUs were at increased risk of dying from hepatitis/liver-related disease (CHR = 7.15, 95% CI: 1.98 to 25.8), other natural causes (CHR = 3.09, 95% CI: 1.41 to 6.79), and nonnatural causes (CHR = 2.30, 95% CI: 1.07 to 4.95) in the HAART era.

Conclusions: HCV/HIV-coinfected DUs remain at increased risk of dying from hepatitis/liver-related death in the HAART era compared with HCV-monoinfected DUs. This risk did not change in HCV/HIV-coinfected DUs after HAART was introduced, suggesting that in the HAART era, HIV continues to accelerate HCV disease progression. Efforts should be made to establish effective treatment for HCV infection in HCV/HIV-coinfected individuals.

From the *Cluster Infectious Diseases, Health Service of Amsterdam, Amsterdam, The Netherlands; †Department of Human Retrovirology, Academic Medical Center, Amsterdam, The Netherlands; ‡Center for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, The Netherlands; §Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands; ∥Center for Infectious Diseases Control, Bilthoven, The Netherlands; and the ¶Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands.

Received for publication July 16, 2007; Accepted October 4, 2007.

The Amsterdam Cohort Studies on HIV Infection and AIDS, a collaboration between the Amsterdam Health Service, the Academic Medical Center of the University of Amsterdam, Sanquin Blood Supply Foundation, and the University Medical Center Utrecht, are part of The Netherlands HIV Monitoring Foundation and financially supported by The Netherlands National Institute for Public Health and the Environment.

There are no competing interests to declare.

Correspondence to: Colette Smit, PhD, Cluster Infectious Diseases, Health Service of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.