CHRONO-OPTIMAL TREATMENTS FOR HIV/HCV CO-INFECTION YIELD COMPARABLE SURVIVAL OUTCOMES WITH HCV MONO-INFECTION

초록

Background: Over the past decades, the treatment of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection has significantly advanced. Previous studies have shown that HIV accelerates HCV progression, leading to increased liver-related complications and mortality. With advances in treatments for HIV/HCV co-infection, our study aims to re assess the effectiveness of various HCV treatments by comparing outcomes between patients with HIV/HCV co-infection and those with HCV mono-infection. Methods: We retrospectively included consecutive patients who were diagnosed and treated for HIV and/or HCV at 12 tertiary referral centers from January 2009 to December 2020. The primary endpoint was overall survival (OS). Secondary endpoints included achievement of a sustained virologic response (SVR), and the incidence of hepatocellular carcinoma (HCC). Results: A total of 908 patients were included: 114 (103 males, mean age of 46.0 ± 13.1 years) were HIV/HCV co-infected, and 794 (341 males, mean age of 58.4 ± 12.2 years) had HCV mono-infection. In the HIV/HCV co-infection group, 97 (85.1%) had received HIV treatment prior to inclusion in the study. In the HIV/HCV co-infection group, 26 (22.8%) were untreated, 30 (26.3%) received pegylated interferon plus ribavirin, and 58 (50.9%) received direct-acting antivirals (DAAs), compared to 52 (6.4%), 213 (26.8%), and 530 (66.8%) respectively in the HCV mono-infection group. The median follow-up duration was 58.2 months in the treated group receiving pegylated interferon plus ribavirin or DAAs. There was no statistically significant difference in OS between the treated HIV/HCV co-infection group and the treated HCV mono-infection group even after inverse probability of treatment weighting (IPTW) (adjusted hazard ratio [aHR], 1.20; 95% confidence interval [CI], 0.25–5.64; P= 0.82; Figure 1A). SVR 12 was achieved significantly less in the HIV/HCV co-infection group (79.5%) compared to the HCV mono-infection group (93.1%) (P< 0.001). The incidence of HCC was 1 (1.14%) in the treated HIV/HCV co-infection group and 48 (6.46%) in the treated HCV mono-infection group, with no statistically significant difference observed after IPTW (aHR 0.32, 95% CI 0.05–2.04, P =0.23; Figure 1B). Conclusion: With the establishment of optimal treatment regimens for HIV/HCV co-infection, the risk of HCC occurrence and mortality in patients with HIV/HCV co-infection have become comparable to those in patients with HCV mono-infection.