Title: Initiation of ART at CD4 count >350 cells/mm
3compared to <350 cells/mm
3among people coinfected with HIV and hepatitis C virus (HCV)
Contents
1. PICO question ... 1
2. Search strategy ... 1
3. Flow diagram of screening process ... 2
4. Evidence summaries ... 3
4.1. Observational studies ... 3
5. Bibliography of included studies ... 4
6. Excluded studies with reasons ... 5
1. PICO question
HCV and HBV combined PICO question
When to start: HIV and HBV and HCV coinfection
P 1) people coinfected with HIV and HCV 2) people coinfected with HIV and HBV I ART initiation at CD4 >350 cells/mm3 or irrespective of CD4 cell count
C Defer ART initiation until CD4 cell count ≤350 cells/mm3 or symptomatic HIV disease (WHO stages 3 and 4)
O HIV mortality and morbidity, non-HIV mortality and morbidity, response to HCV therapy (for HIV and HCV coinfection), HBV transmission (for HIV and HBV coinfection), severe adverse events, adherence, retention, HIV drug resistance, TB incidence
2. Search strategy
HCV and HBV combined search strategy 01 Jan 1996 – 2 Aug 2012
Search Query
#6 Search ((((#1) AND #2) AND #3) AND #4) AND #5
#5 Search HAART[tiab] OR ART[tiab] OR antiretroviral[tiab] OR anti-retroviral[tiab] OR
"Anti-HIV Agents/therapeutic use"[MeSH] OR "Drug Therapy,
Combination/methods"[MeSH] OR Antiretroviral Therapy, Highly Active[MeSH]
#4 Search randomized controlled trial [pt] OR controlled clinical trial [pt] OR randomized controlled trials [MeSH] OR random allocation [MeSH] OR double-blind method [MeSH]
OR single-blind method [MeSH] OR clinical trial [pt] OR clinical trials [MeSH] OR ("clinical trial" [tiab]) OR ((singl* [tiab] OR doubl* [tiab] OR trebl* [tiab] OR tripl* [tiab]) AND (mask* [tiab] OR blind* [tiab])) OR (placebos [MeSH] OR placebo* [tiab] OR random* [tiab] OR research design [mh:noexp] OR follow-up studies [MeSH] OR
prospective studies [MeSH] OR control*[tiab] OR prospectiv* [tiab]) OR nonrandomi*[tiab]
This work was commissioned by the World Health Organization and carried out by The University of California, San Francisco (UCSF),
259 duplicates removed
56 irrelevant articles removed
518 total records excluded 29 additional
records identified through other
sources
40 full-text articles assessed for eligibility
(69 total) 492 records screened by
two authors working independently 548 records screened by
one author 807 records identified
through database searching
3 studies included in review Search Query
cohort[tiab] OR cohort*[tiab] OR cross-section*[tiab] OR prospective[tiab] OR retrospective[tiab] OR research design[mh:noexp] OR follow-up studies[MeSH] OR prospective studies[MeSH] OR control*[tiab] OR prospectiv*[tiab]) NOT (animals [MeSH]
NOT human [MeSH])
#3 Search (start*[tiab] OR initia*[tiab] OR begin*[tiab] OR timing[tiab] OR early[tiab] OR earli*[tiab] OR (CD4[tiab] AND (irrespective[tiab] OR “above 350”[tiab] OR ≥350[tiab]
OR >350[tiab]))
#2 Search "Hepatitis, Viral, Human"[Mesh] OR "viral hepatitis"[tiab] OR "hepatitis B"[tiab] OR HBV[tiab] OR "hepatitis C"[tiab] OR HCV[tiab]
#1 Search HIV Infections[MeSH] OR HIV[MeSH] OR hiv[tiab] OR hiv-1*[tiab] OR hiv- 2*[tiab] OR hiv1[tiab] OR hiv2[tiab] OR hiv infect*[tiab] OR human immunodeficiency virus[tiab] OR human immunedeficiency virus[tiab] OR human immuno-deficiency
virus[tiab] OR human immunedeficiency virus[tiab] OR ((human immun*) AND (deficiency virus[tiab])) OR acquired immunodeficiency syndrome[tiab] OR acquired immunedeficiency syndrome[tiab] OR acquired immuno-deficiency syndrome[tiab] OR acquired immune- deficiency syndrome[tiab] OR ((acquired immun*) AND (deficiency syndrome[tiab]))
3. Flow diagram of screening process
4. Evidence summaries
4.1.Observational studies Outcome: mortality
• In one cohort (Moore 2006) with 673 HIV-infected, HCV-seropositive, ART-naive patients with a median of 47.1 months of follow-up, the risk of non-accidental death was significantly lower in those who started ART with CD4 ≥350 cells/mm3 compared to those starting at <350 cells/mm3 (rate ratio 0.39, 95% CI 0.25–0.60).1 The quality of evidence is low and was downgraded for imprecision (few events) and risk of bias. Only unadjusted data were available to address this question. Person time of observation by stratum of CD4 cell count was not reported. There may be incomplete ascertainment of patients who died after moving out of the province. This study provides indirect evidence due to two issues with the study population. First, some patients may have been HCV-antibody positive but did not have chronic HCV infection since HCV viraemia was not ascertained. Second, while this was a population-based cohort, more than 26% were excluded due to lack of HCV serology, and the authors report that excluded patients had significant differences in risk factors for HCV and mortality.
Outcome: increase in CD4 cell count 16 weeks and 48 weeks after ART initiation
• In a cohort of 40 people with HIV with HCV viraemia from an AIDS Clinical Trial Group (ACTG) study (Chung 2002), those who started ART with CD4 >350 cells/mm3 had no
statistically significant difference in their mean CD4 cell count increase when compared to those who started ART with ≤350 cells/mm3 (mean difference (MD) at 16 weeks after ART initiation was 45 cells/mm3 higher (95% CI 31.47 lower to 121.47 higher); MD at 48 weeks was 5
cells/mm3 lower (95% CI 131.02 lower to 121.02 higher). The quality of the evidence is low and is downgraded for imprecision (few events) and risk of bias (no adjustment for confounders).
• Braitstein (2006) reports on a cohort of 606 ART-naïve, HCV antibody-positive people with HIV from the same Canadian treatment centre as Moore (2006). Among people who were ≥95%
adherent to ART, the adjusted mean CD4 increase at 48 weeks after ART initiation was 68 cells/mm3 among those with baseline CD4 >350/mm3, compared to 72 cells/mm3 among those with baseline CD4 <350 cells/mm3. The adjusted change in CD4 cell fraction was 2.5% among people with baseline CD4 cell count ≥350/mm3, compared to 3.0% among people with baseline CD4 cell counts of <350 cells/mm3. The reported data are inadequate to test the significance of these differences across CD4 cell count strata.
Outcome: increase in HCV RNA measured at 16 and 48 weeks after ART initiation2
• In the same 2002 paper, Chung reports on another cohort of people with HIV with HCV viraemia drawn from six ACTG treatment trials. At 16 weeks after ART initiation, those who started ART with CD4 >350 cells/mm3 had no statistically significant difference in their HCV RNA increases when compared to those who started ART with ≤350 cells/mm3 (MD0.17 log10 HCV RNA lower, 95% CI 0.6 lower to 0.26 higher). However, at 48 weeks, the patients initiating ART at higher CD4 levels had significantly smaller increases in their HCV RNA levels (MD 0.49 log10 HCV RNA lower, 95% CI 0.94 to 0.04 lower). Of note, the patients starting ART with CD4 counts
1 3 3
This work was commissioned by the World Health Organization and carried out by The University of California, San Francisco (UCSF),
>350 cells/mm3 had significant increases in HCV-RNA levels early in ART but then returned toward baseline. By contrast, patients starting ART with CD4 cell counts less than 350 cells/mm3 had early rises in HCV-RNA that remained elevated through the end of the observation period at 48 weeks.
The quality of the evidence is low and is downgraded for imprecision (few events) and risk of bias (no adjustment for confounders). This study provides indirect evidence because it reports surrogate markers that are less patient-important than morbidity or mortality.
5. Bibliography of included studies
1. Deng L, Gui X, Xiong Y, et al. End-stage liver disease: prevalence, risk factors and clinical characteristics in a cohort of HIV-HCV coinfected Han Chinese. Clin Res Hepatol Gastroenterol 2012; 36:574-82.
2. Limketkai BN, Mehta SH, Sutcliffe CG, et al. Relationship of liver disease stage and antiviral therapy with liver-related events and death in adults coinfected with HIV/HCV. JAMA 2012;
308:370-78.
3. Loko MA, Bani-Sadr F, Valantin MA, Lascoux-Combe C, Fontaine H, Bonnard P, Gervais A, Bouchaud O, Garipuy D, Quertainmont Y, Vittecoq D, Tehrani MS, Winnock M, Dabis F, Salmon D. Antiretroviral therapy and sustained virological response to HCV therapy are
associated with slower liver fibrosis progression in HIV-HCV-coinfected patients: study from the ANRS CO 13 HEPAVIH cohort. Antivir Ther 2012 17:7, 1335-1343.
4. Macías J, Berenguer J, Japon MA, et al. Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus. Hepatology 2009;
50:1056-63.
5. Macías J, Berenguer J, Japón MA, et al. Hepatic steatosis and steatohepatitis in human immunodeficiency virus/hepatitis C virus-coinfected patients. Hepatology 2012; 56:1261-70.
6. Mariné-Barjoan E, Saint-Paul M-C, Pradier C, et al. Impact of antiretroviral treatment on progression of hepatitic fibrosis in HIV/hepatitis C virus co-infected patients. AIDS 2004;
18:2163-70.
7. Qurishi N, Kreuzberg C, Luchters G, et al. Effect of antiretroviral therapy on liver-related mortality in patients with HIV and hepatitis C virus coinfection. Lancet 2003; 362:1708-13.
8. Ragni MV, Nalesnik MA, Schillo R, Dang Q. Highly active antiretroviral therapy improves ESLD-free survival in HIV-HCV co-infection. Haemophilia 2009; 15:552-58.
9. Sulkowski MS, Mehta SH, Torbenson MS, et al. Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults. AIDS 2007; 21:2209-16.
10. Tural C, Fuster D, Tor J, et al. Time on antiretroviral therapy is a protective factor for liver fibrosis in HIV and hepatitis C virus (HCV) co-infected patients. J Viral Hepat 2003; 10:118–25.
11. Verma S, Wang CH, Govindarajan S, et al. Do type and duration of antiretroviral therapy attenuate liver fibrosis in HIV-hepatitis C virus- coinfected patients? Clin Infect Dis 2006;
42:262–70.
12. Verma S, Goldin RD, Main J. Hepatic steatosis in patients with HIV-hepatitis C virus coinfection:
is it associated with antiretroviral therapy and more advanced hepatic fibrosis? BMC Res Notes 2008; 1:46.
6. Excluded studies with reasons
Excluded studies Reason
Agbaji O, Thio CL, Meloni S, et al. Impact of hepatitis C virus on HIV response to antiretroviral therapy in Nigeria. J Acquir Immune Defic Syndr 2013; 62:204-07.
All 79 people coinfected with HCV and HIV received ART
Antonucci G, Girardi E, Cozzi-Lepri A, et al. Role of hepatitis C virus (HCV) viremia and HCV genotype in the immune recovery from highly active antiretroviral therapy in a cohort of antiretroviral-naive HIV-infected individuals. Clin Infect Dis 2005; 40:e101-109.
Only outcome is CD4 count. No hepatic disease outcomes
Berenguer J, Alejos B, Hernando V, et al. Trends in mortality according to hepatitis C virus serostatus in the era of
combination antiretroviral therapy. AIDS 2012; 26:2241-46.
Ecological study comparing liver- related deaths among people coinfected with HIV and HCV in two eras; ART status not reported for individual patients
Braü N, Salvatore M, Ríos-Bedoya CF, et al. Slower fibrosis progression in HIV/HCV-coinfected patients with successful HIV suppression using antiretroviral therapy. J Hepatol 2006;
44:47-55.
Does not report outcome (fibrosis progression rate) by ART exposure status (but does by viral load).
Bruyand M, Dabis F, Vandenhende MA, et al. HIV-induced immune deficiency is associated with a higher risk of hepatocarcinoma, ANRS CO3 Aquitaine Cohort, France, 1998-2008. J Hepatol 2011; 55:1058-62.
ART treatment status of people coinfected with hepatitis and HIV not reported, either for those with
hepatocellular cancer or those without hepatocarcinoma
Caudai C, Pianese M, Zacchini F, Toti M, Zazzi M, Valensin PE. Longitudinal study in HIV/HCV-coinfected HAART- naive patients and role of HCV genotype. J Clin Virol 2005;
32:151-55.
Retrospective cohort: before and after
Chadwick D, Ankcorn M, Sarfo F, et al. Outcomes of starting first-line antiretroviral therapy in hepatitis B virus/HIV- coinfected patients in Ghana. J Antimicrob Chemother 2012;
67:2939-42.
Does not report hepatic outcomes in people coinfected with HBV and HIV by ART status
De Luca A, Bugarini R, Lepri AC, et al. Coinfection with hepatitis viruses and outcome of initial antiretroviral regimens in previously naive HIV-infected subjects. Arch Intern Med 2002; 162:2125-32.
Only outcomes are AIDS defining diseases, deaths, immunological and HIV viral load: no hepatic outcomes
This work was commissioned by the World Health Organization and carried out by The University of California, San Francisco (UCSF),
Excluded studies Reason
DiMartino V, Thevenot T, Colin J-F, et al. Influence of HIV infection on the response to interferon therapy and the long- term outcome of chronic hepatitis B. Gastroenterology 2002;
123: 1812-22.
No discussion of HAART (except at baseline)
Dore G, Sorian V, Rockstroh J, et al for the SMART INSIGHT study group. Frequent hepatitis B virus rebound among HIV-HBV coinfected patients following antiretroviral therapy interruption in the SMART study. AIDS 2010;
24:857-65.
Endpoint is HBV rebound when ART is interrupted
Emery S, Neuhaus JA, Phillips AN, et al. Major clinical outcomes in antiretroviral therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study. J Infect Dis 2008; 197:1133-44.
SMART cohort; no comparison of people coinfected with hepatitis and HIV by CD4 at ART start
Fernandez-Montero JV, Barreiro P, Vispo E, Labarga P, Sanchez-Parra C, Soriano V. Liver stiffness predicts liver- related complications and mortality in HIV patients with chronic hepatitis C on antiretroviral therapy. AIDS 2013;
27:1129-34.
All but 3 patients received ART, which is not further described
Greub G, Ledergerber B, Battegay M, et al. Clinical progression, survival, and immune recovery during
antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study. Lancet 2000;
356:1800-05.
Outcomes are AIDS defining clinical event, HIV viral load, CD4 recovery.
End-stage liver disease included as cause of death, but not reported for HCV coinfected patients by ART status.
All cohorts started with potent ART Hawkins C, Christian B, Ye J, et al. Prevalence of hepatitis B
co-infection and response to antiretroviral therapy among HIV-infected patients in urban Tanzania. AIDS 2012; 27:919- 27.
Effect of HBV status on ART outcomes by treatment regimen is examined, but only HBV active versus not HBV active regimens
Hoffmann CJ, Charalambous S, Martin DJ, Innes C,
Churchyard GJ, Chaisson RE, Grant AD, Fielding KL, Thio CL. Hepatitis B virus infection and response to antiretroviral therapy (ART) in a South African ART program. Clin Infect Dis 2008 47:1479-1485
No comparison by ART status (all started ART). Only hepatic outcome is hepatotoxicity on ART
Hoffmann CJ, Seaberg EC, Young S, et al. Hepatitis B and long-term HIV outcomes in coinfected HAART recipients.
AIDS 2009; 23:1881-89.
No comparison of patients treated with HAART or not. All received HAART.
Liver-related deaths reported in chronic HBV, but not by HAART yes or no Hung CC, Chen MY, Hsieh SM, Hsiao CF, Sheng WH, Chang
SC. Impact of chronic hepatitis C infection on outcomes of patients with an advanced stage of HIV-1 infection in an area of low prevalence of co-infection. Int J STD AIDS 2005;
16:42-48.
89% of 53 people with HCV and HIV received HAART. Hepatitis and deaths from hepatic complications are not reported by HAART status. Only comparison is ecological (Table 2), where incidence of acute hepatitis rose after the HAART era
Konopnicki D, Mocroft A, de Wit S, et al. Hepatitis B and HIV: prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort. AIDS 2005; 19:593-601.
All started HAART
Excluded studies Reason Kramer JR, Giordano TP, Souchek J, Richardson P, Hwang
LY, El-Serag HB. The effect of HIV coinfection on the risk of cirrhosis and hepatocellular carcinoma in U.S. veterans with hepatitis C. Am J Gastroenterol 2005; 100:56-63.
Stratified analysis by pre-HAART and HAART eras
Lee T, Nunez M. Longer duration of HBV-active antiretroviral therapy is linked to favorable virological outcome in HIV- HBV co-infected patients. HIV Clin Trials 2009; 10:153-59.
Among 72 patients with HIV-HBV, 89% took treatment with HAART containing anti-HBV drugs. Deaths from liver disease and liver
complications are reported but not by HAART status
Lincoln D, Petoumenos K, Dore GJ. HIV/HBV and HIV/HCV coinfection, and outcomes following highly active
antiretroviral therapy. HIV Med 2003; 4:241-49.
Hepatic outcomes not reported for people coinfected with hepatitis and HIV by ART status
Lumbreras B, Jarrin I, del Amo J, et al. Impact of hepatitis C infection on long-term mortality of injecting drug users from 1990 to 2002: differences before and after HAART. AIDS 2006; 20:111-16.
Does not report numerators for outcomes (and predictor was <1997 or
≥1997) Maimaiti R, Zhang Y, Pan K, Wubuli M, Andersson R.
Frequent coinfection with hepatitis among HIV-positive patients in Urumqi, China. J Int Assoc Physicians AIDS Care 2013; 12:58-61.
No report of hepatic outcomes by ART status for coinfected patients
Maman D, Pujades-Rodriguez M, Nicholas S, McGuire M, Szumilin E, et al. Response to antiretroviral therapy in sub- Saharan Africa: improved survival associated with CD4 above 500 cells/mm3. AIDS 2012; 26:1393–98.
Médecins Sans Frontières cohort.
Hepatitis not mentioned
Matthews GV, Manzini P, Hu Z, et al. Impact of lamivudine on HIV and hepatitis B virus-related outcomes in
HIV/hepatitis B virus individuals in a randomized clinical trial of antiretroviral therapy in southern Africa. AIDS 2011;
25:1727-35.
HIV/HBC patients randomized to receive:
I: lamuvidine containing ART (n = 57) C: no 3TC (n = 49)
Mauelshagen A, Horst H, Stellbrink H, Hoffmann C. Long- term safety and tolerability of nevirapine and efavirenz- containing regimens in HIV/HCV-coinfected patients. J Int AIDS Soc 2012; 15:18416.
Reports liver toxicity of EFV versus NVP among people with HCV and HIV.
Exclude since no comparison of ART versus no ART
Mazzotta E, Agostinone A, Sozio F, et al. Prevalence and predictors of solid or hematological malignancies in a monocentric cohort of HIV patients from central Italy. J Int AIDS Soc 2012; 15(Suppl 4):18084.
Exclude since no comparison of ART versus no ART in the people with hepatitis and HIV with malignancies Mehta SH, Thomas DL, Torbenson M, et al. The effect of
antiretroviral therapy on liver disease among adults with HIV and hepatitis C coinfection. Hepatology 2005; 41:123-31.
Numerators not reported by ART exposure status
Mohsen AH, Easterbrook PJ, Taylor C, et al. Impact of human immunodeficiency virus (HIV) infection on the progression of liver fibrosis in hepatitis C virus infected patients. Gut 2003;
52:1035-40.
Numerators not reported by ART exposure status
Nikolopoulos G, Paraskevis D, Hatzitheodorou E, et al. Impact of hepatitis B virus infection on the progression of AIDS and mortality in HIV-infected individuals: a cohort study and
All patients started HAART
This work was commissioned by the World Health Organization and carried out by The University of California, San Francisco (UCSF),
Excluded studies Reason
Omland LH, Weis N, Skinhoj P, et al. Impact of hepatitis B virus co-infection on response to highly active antiretroviral treatment and outcome in HIV-infected individuals: a nationwide cohort study. HIV Med 2008; 9:300-06.
HBV-active ARV regimen had no significant impact on overall mortality rate ratio for HBV+ patients but not reported for liver-related deaths Parenti P, Marconi L, Lupo S. Hepatotoxicity of antiretrovirals
in patients with human immunodeficiency virus and viral hepatitis coinfections. J Int AIDS Soc 2012; 15:18431.
Only abstract is available. Reports hepatotoxicity when people with hepatitis and HIV started ART. Exclude since no comparison group without ART exposure
Pereira N, Caldas C, Azevedo C, Andrade P, Serrao R, Sarmento A. Infections and cancer after ARV: a Portuguese cohort. J Int AIDS Soc 2012; 15:18123.
Only abstract is available-Does not report hepatocellular carcinoma by ART status in people with hepatitis and HIV Peters L, Mocroft A, Soriano V, et al. Hepatitis C virus
coinfection does not influence the CD4 cell recovery in HIV- 1-infected patients with maximum virologic suppression. J Acquir Immune Defic Syndr 2009; 50:457-63.
Only outcome is CD4 recovery; no hepatic outcomes in abstract
Podzamczer D, Tiraboschi JM, Mallolas J, et al. Long-term benefits of nevirapine-containing regimens: multicenter study with 506 patients, followed-up a median of 9 years. Curr HIV Res 2012; 10:513-20.
All patients treated with ART including NVP
Posthouwer D, Makris M, Yee TT, at al. Progression to end- stage liver disease in patients with inherited bleeding disorders and hepatitis C: an international, multicenter cohort study.
Blood 2007; 109:3667-71.
Does not report numerators (rate ratio=0.8 for end-stage liver disease)
Potter M, Odueyungbo A, Yang H, Saeed S, Klein MB.
Impact of hepatitis C viral replication on CD4+ T-lymphocyte progression in HIV-HCV coinfection before and after
antiretroviral therapy. AIDS 2010; 24:1857-65.
Outcome is rate of CD4 cell count change; no hepatic outcomes in abstract
Sheng WH, Chen MY, Hsieh SM, et al. Impact of chronic hepatitis B virus (HBV) infection on outcomes of patients infected with HIV in an area where HBV infection is hyperendemic. Clin Infect Dis 2004; 38:1471-77.
The only report of hepatic outcome by ART status is with or without 3TC
Silverberg M, Neuhaus J, Bower M. Risk of cancers during interrupted ART in the SMART study. AIDS 2007; 21:1957- 63.
HBV or HBC were not significant predictors for non-AIDS-defining malignancies (but hepatocellular carcinoma not specified except in Table 3, which presented no information on hepatitis infection)
SMART Study Group. Clinical outcomes in ART-naïve participants and in those not receiving ART at baseline in the SMART study. J Infect Dis 2008; 197:1133-44.
No outcomes reported for people coinfected with hepatitis and HIV SMART Study Group, Peters L, Neuhaus J, et al. Hyaluronic
acid levels predict increased risk of non-AIDS death in hepatitis-coinfected persons interrupting antiretroviral therapy in the SMART Study. Antivir Ther 2011; 16:667-75.
Combines HBV and HCV into outcomes and does not provide numerators for outcomes
Excluded studies Reason Smit C, van den Berg C, Geskus R, Berkhout B, Coutinho R,
Prins M. 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. J Acquir Immune Defic Syndr 2008; 47:
221-25.
Does not report numerators (adjusted rate ratio 0.87 for morality)
Sterling RK, Wilson MS, Sanyal AJ, et al. Impact of highly active antiretroviral therapy on the spectrum of liver disease in HCV-HIV coinfection. Clin Gastroenterol Hepatol 2004;
2:432-39.
All patients on HAART. Compares PI use to NNRTI use
Stuver SO, Fleming C, Nunes D, et al. Predictors of liver disease progression in a cohort of HIV/HCV-co-infected drug users [abstract 947]. In: Program and Abstracts of the 12th Conference on Retroviruses and Opportunistic Infections (Boston). Alexandria, VA: Foundation for Retrovirology and Human Health; 2005:422.
Does not report ART numerators or denominators (adjusted hazard ratio=0.29 for clinical progression or death from hepatic causes)
Sulkowski MS, Moore RD, Mehta SH, Chaisson RE, Thomas DL. Hepatitis C and progression of HIV disease. JAMA 2002;
288:199-206.
No hepatic outcomes reported
Tedaldi E, Peters L, Neuhaus J, et al. Opportunistic disease and mortality in patients coinfected with hepatitis B or C virus in the strategic management of antiretroviral therapy
(SMART) study. Clin Infect Dis 2008; 47:1468-75.
Cannot distinguish HCV from HBV. Do not know person years to calculate our own liver-related event rates (from Table 2 and Fig. 2) to limit the results to the two hepatic deaths
Thein HH, Yi Q, Dore GJ, Krahn MD. Natural history of hepatitis C virus infection in HIV-infected individuals and the impact of HIV in the era of highly active antiretroviral therapy: a meta-analysis. AIDS 2008; 22:1979-91.
Analysis was stratified by HAART or no HAART for cirrhosis risk factors and individual cells are not calculable Thio C, Seaberg E, Skolasky R, et al. HIV-1, hepatitis B virus,
and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet 2002; 360:1921-26.
The HAART status of people positive for hepatitis B surface antigen and coinfected with HIV is not described (only ecological data: after 1996, 50–
65% of the whole cohort of people with HIV (regardless of HBV status) had begun HAART
Zhou J, Dore GJ, Zhang F, Lim PL, Chen YM. Hepatitis B and C virus coinfection in The TREAT Asia HIV Observational Database. J Gastroenterol Hepatol 2007; 22:1510-18.
Elevated ALT is a “hepatic outcome”
but article does not report on ART status among people coinfected with hepatitis
