Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response
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Data on the effects of sustained virologic response (SVR) to hepatitis C virus (HCV) therapy on the outcome of extrahepatic complications are scarce. We conducted this study to assess the impact of SVR on the occurrence of chronic kidney disease (CKD), diabetes mellitus (DM), and cardiovascular disease (CVD) in a cohort of human immunodeficiency virus (HIV)-infected patients. We analyzed coinfected HIV/HCV patients in the Management of Standardized Evaluation of Retroviral HIV Infection (MASTER) cohort. Only event-free patients with a serum HCV-RNA determination at baseline were included. Patients were divided into four groups: INF-exposed with SVR; INF-exposed without SVR; spontaneous HCV clearance; untreated viremic patients. We estimated the incidence of extrahepatic complications and employed Kaplan–Meier curves and Cox regression to assess the association of SVR/INF strata adjusted for a series of confounders. Data from 1676 patients were analyzed (20.29 % started an INF-based regimen). Overall, the incidence of CKD, DM, CVD, and death was 5.32 [95 % confidence interval (CI) 3.99–6.98], 10.13 (95 % CI 8.20–12.37), 6.79 (95 % CI 5.26–8.65), and 13.49 (95 % CI 11.29–16.0) per 1000 person-years of follow-up, respectively. In the Cox model for treated patients, SVR was not associated with a lower risk of CKD, DM, CVD, and death compared to non-SVR. Cirrhosis was significantly associated with a higher risk of CKD [hazard ratio (HR) 2.13; 95 % CI 1.06–4.31], DM (HR 3.48; 95 % CI 2.18–5.57), and death (HR 6.18; 95 % CI 4.1–9.31), but not of CVD (HR 1.14; 95 % CI 0.57–2.3). There are still many unknowns regarding the impact of SVR on the occurrence of extrahepatic complications in coinfected HIV/HCV patients. Further investigations are needed in order to elucidate the role of SVR as an independent prognostic factor for extrahepatic events.
KeywordsHuman Immunodeficiency Virus Chronic Kidney Disease Sustained Virologic Response Body Mass Index Group Normal Body Mass Index Group
The MASTER study is sponsored by the M.I.S.I. Foundation (Fondazione Malattie Infettive e Salute Internazionale, http://www.fondazionemisi.it). We would like to thank all patients participating in the MASTER cohort study, all doctors and study nurses involved, and the data center. We would also like to thank ANLAIDS (National Association against AIDS), Sezione Lombardia for its continuous support of our work. Preliminary results of this study were presented at the 22nd Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, WA, 23–26 February 2015, abstract number 655.
Compliance with ethical standards
None to declare.
Conflict of interest
SL received speaker grants from Janssen-Cilag, Pfizer, and travel grants from Gilead, Janssen-Cilag, Pfizer. SC received speaker grants from Abbvie, BMS, Gilead, MSD, Viiv, and travel grants from BMS, Gilead, ViiV, is a member of the advisory boards of Abbvie, scientific debrief for Gilead, employee of Gilead from August 2012 to July 2013; PN received speaker grants and advisory board honoraria from BMS, MSD, Viiv; AS received payment for the development of educational presentations from BMS, Gilead, MSD, ViiV; MDP received speaker grants from Abbvie, BMS, Gilead, MSD, Viiv, is a member of the advisory boards of Abbvie; AG received grants/research supports from Abbvie, Astellas, BMS, Boehringer, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, ViiV, ANLAIDS Sezione Lombarda, honoraria or consultation fees from BMS, Gilead, Janssen, MSD, Novartis, ViiV, travel grant/supports from BMS, Gilead, Jansen, ViiV, and participation in a company-sponsored speakers’ bureau of Gilead. The other authors declare no conflict of interests.
Each site obtained approval by a local Ethics Committee.
Informed consent was obtained from all individual participants included in the study.
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