No Impact of HIV Coinfection on Mortality in Patients With Hepatitis C Virus Infection After Sustained Virological Response

BACKGROUND: In patients with hepatitis C virus (HCV) chronic infection and advanced liver disease, the impact of human immunodeficiency virus (HIV) coinfection on the clinical outcome after sustained virological response (SVR) has not been sufficiently clarified. The aim of this study was to compare the mortality after SVR of patients bearing HCV chronic infection and advanced liver fibrosis, with and without HIV coinfection after a prolonged follow-up. METHODS: This was a prospective multicenter cohort study including individuals with HIV/HCV coinfection and patients with HCV monoinfection from Spain, fulfilling (1) liver stiffness (LS) ≥9.5 kPa before treatment, (2) SVR with a direct-acting antiviral-based regimen, and (3) LS measurement available at SVR. The main outcome was overall survival. Mortality attributable to liver disease and nonhepatic causes was also assessed. RESULTS: A total of 1118 patients were included, of whom 676 (60.5%) had HIV. The median (Q1-Q3) follow-up was 76 (57-83) months. After SVR, 46 (10%) HCV-monoinfected and 74 (11%) HIV/HCV-coinfected patients died. The overall mortality rate (95% CI) was 1.9 (1.6-2.2) per 100 person-years, 1.9 (1.4-2.5) per 100 person-years in patients with HCV monoinfection, and 1.8 (1.6-2.3) per 100 person-years in people with HIV. In the multivariable analysis, HIV coinfection was not associated with shorter survival (hazard ratio, .98; 95% CI, .61-1.58; P = .939). CONCLUSIONS: In patients with HCV chronic infection and advanced fibrosis, HIV coinfection does not reduce the overall survival after SVR. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov (NCT04460157).