Hepatitis C Virus Infection-Related Morbidity and Mortality among Patients with Human Immunodeficiency Virus Infection [Monga HK et al. CID 2001;33:240]: This is a report from the VA Hospital in Houston, which evaluated 263 patients with HIV infection alone, 60 with HCV alone, and 166 who were co-infected. The mean duration of follow-up was two years and ten months. The two groups with HIV-infected patients had comparable CD4 cell counts and viral loads. There was a favorable outcome in those with HCV alone, but co-infected patients had a significant increase in mortality and in mortality attributed to hepatic failure. Details are summarized below:

	HCV n = 60	HIV n = 263	HCV + HIV n = 166
Hepatic failure	0	0	14 (8%)
Hepatocellular ca	0	0	2 (1%)
Mortality	0	18 (7%)	19 (11%)
Liver deaths	0	0/18	9/19 (47%)

Comment: This is an interesting paper that deals with one of the most important issues in HIV care. Multiple studies have shown through long-term follow-up of patients with HCV that the great majority do well, making indications for therapy difficult to define. In co-infected patients, it appears that the impact on HIV progression is relatively modest or nil, but there appears to be substantial progression in HCV-induced disease. In fact, alcoholism and HIV appear to be the two most important factors in promoting HCV progression. This report supports these claims, and also suggests that the urgency to treat HCV may be substantially greater in co-infected patients. Current guidelines do not address this, but several guideline groups are now addressing the issue.
posted 8/17/2001

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