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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antiretroviral therapy reduces the rate of hepatic decompensation among HIV-and hepatitis C virus-coinfected veterans
Clinical Infectious Diseases, Volume 58, No. 5, Year 2014
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Description
Background. Human immunodeficiency virus (HIV) coinfection accelerates the rate of liver disease outcomes in individuals chronically infected with hepatitis C virus (HCV). It remains unclear to what degree combination antiretroviral therapy (ART) protects against HCV-associated liver failure.Methods. We evaluated 10 090 HIV/HCV-coinfected males from the Veterans Aging Cohort Study Virtual Cohort, who had not initiated ART at entry, for incident hepatic decompensation between 1996 and 2010. We defined ART initiation as the first pharmacy fill date of a qualifying ART regimen of ≥3 drugs from ≥2 classes. Hepatic decompensation was defined as the first occurrence of 1 hospital discharge diagnosis or 2 outpatient diagnoses for ascites, spontaneous bacterial peritonitis, or esophageal variceal hemorrhage. To account for potential confounding by indication, marginal structural models were used to estimate hazard ratios (HRs) of hepatic decompensation, comparing initiation of ART to noninitiation.Results. We observed 645 hepatic decompensation events in 46 444 person-years of follow-up (incidence rate, 1.4/100 person-years). Coinfected patients who initiated ART had a significantly reduced rate of hepatic decompensation relative to noninitiators (HR = 0.72; 95% confidence interval [CI],. 54-.94). When we removed individuals with HIV RNA ≤400 copies/mL at baseline from the analysis (assuming that they may have received undocumented ART at entry), the hazard ratio became more pronounced (HR = 0.59; 95% CI,. 43-.82).Conclusions. Initiation of ART significantly reduced the rate of hepatic decompensation by 28%-41% on average. These results suggest that ART should be administered to HIV/HCV-coinfected patients to lower the risk of end-stage liver disease. © 2013 The Author.
Authors & Co-Authors
Anderson, Jeffrey P.
Unknown Affiliation
Tchetgen, Eric
Unknown Affiliation
Lo Re, Vincent
Unknown Affiliation
Tate, Janet P.
Unknown Affiliation
Williams, Paige L.
Unknown Affiliation
Seage, George R.
Unknown Affiliation
Horsburgh, Charles Robert
Unknown Affiliation
Lim, Joseph K.
Unknown Affiliation
Bidwell Goetz, Matthew Bidwell
Unknown Affiliation
Rimland, David
Unknown Affiliation
Rodriguez-Barradas, Maria C.
Unknown Affiliation
Butt, Adeel A.
Unknown Affiliation
Klein, Marina Barbara
Unknown Affiliation
Justice, Amy C.
Unknown Affiliation
Statistics
Citations: 59
Authors: 14
Affiliations: 17
Identifiers
Doi:
10.1093/cid/cit779
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative