Mortality in HCV-cured versus HCV-uninfected people with HIV: a matched analysis in the ANRS CO4 FHDH cohort.

OBJECTIVE: It is unknown whether HCV-cured people with HIV (PWH) without cirrhosis reached the same mortality risk as HCV-uninfected PWH. We aimed to compare mortality in PWH cured of HCV by direct-acting antivirals (DAAs) to mortality in individuals with HIV monoinfection.

DESIGN: Nationwide hospital cohort.

METHODS: HIV-controlled participants without cirrhosis and HCV-cured by DAAs started between 09/2013 and 09/2020, were matched on age (±5 years), sex, HIV transmission group, AIDS status, and BMI (±1 kg/m2) to up to ten participants with a virally suppressed HIV monoinfection followed at the time of HCV cure ± 6 months. Poisson regression models with robust variance estimates were used to compare mortality in both groups after adjusting for confounders.

RESULTS: The analysis included 3961 HCV-cured PWH (G1) and 33 872 HCV-uninfected PWH (G2). Median follow-up was 3.7 years in G1 (interquartile range (IQR): 2.0-4.6), and 3.3 years (IQR: 1.7-4.4) in G2. Median age was 52.0 years (IQR: 47.0-56.0), and 29 116 (77.0%) were men. There were 150 deaths in G1 (adjusted incidence rate (aIR): 12.2/1000 person-years) and 509 (aIR: 6.3/1000 person-years) in G2, with an incidence rate ratio (IRR): 1.9 [95%CI, 1.4-2.7]. The risk remained elevated 12 months post HCV cure (IRR: 2.4 [95%CI, 1.6-3.5]). Non-AIDS/nonliver-related malignancy was the most common cause of death in G1 (28 deaths).

CONCLUSIONS: Despite HCV cure and HIV viral suppression, after controlling on factors related to mortality, DAA-cured PWH without cirrhosis remain at higher risk of all-cause mortality than people with HIV monoinfection. A better understanding of the determinants of mortality is needed in this population.