Pretreatment anemia raises mortality risk among HCV/HIV coinfected patients

Erqou S. J Viral Hep. 2013;doi:10.1111/jvh.12107.

May 8, 2013

Patients coinfected with hepatitis C and HIV are at increased risk for death with the presence of pretreatment anemia, while the initiation of therapy for HCV improves survival in this population, according to recent results.

Researchers evaluated data from 5,000 patients coinfected with hepatitis C and HIV, including 1,671 participants who had anemia before undergoing therapy during a maximum follow-up of 7 years. Data were collected from the Electronically Retrieved Cohort of Hepatitis C-Infected Veterans. All-cause mortality rates were determined and compared between those with and without pretreatment anemia, and between anemic patients who did and did not initiate HCV treatment.

Multivariate analysis indicated significant associations between pretreatment anemia and factors including advanced age (OR=2.1; 95% CI, 1.46-3.03 for every 5 years), African-American race (OR=2.11; 95% CI, 1.79-2.5) and the presence of chronic kidney disease (OR=3.34; 95% CI, 2.8-4), decompensated liver disease (OR=2.56; 95% CI, 2.18-3.01) and cancer (OR=1.64; 95% CI, 1.29-2.09).

Within the cohort, 333 nonanemic patients and 84 with anemia initiated therapy for HCV. Anemic patients were less likely than nonanemic participants to undergo therapy (OR=0.48; 95% CI, 0.37-0.61).

During follow-up, anemic patients had significantly higher mortality rates (144.2 deaths per 1,000 person-years compared with 47.5 among those without anemia), while anemic patients who initiated HCV treatment had lower rates than those who did not (66.6 per 1,000 person-years vs. 149.5). Undergoing therapy for HCV was significantly associated with an improved mortality rate (HR=0.41; 95% CI, 0.29-0.58). Adjustment for covariates, including the presence of multiple comorbidities, did not eliminate the significance of the association (HR=0.36; 95% CI, 0.21-0.62).

“Our study demonstrated that HCV treatment is associated with substantial survival benefit in HCV/HIV coinfected individuals with pretreatment anemia,” the researchers concluded. “The importance of these findings is heightened because this group of patients has significantly higher mortality and lower HCV treatment rates as compared to those without anemia. Further study is needed to find strategies … in optimizing HCV treatment to improve HCV treatment rates among this group.”

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