Study Suggests Chronic Kidney Failure Associated with Increased Mortality among Veterans with HIV and Hepatitis C Virus

In the United States, up to 30% of HIV-infected individuals are co-infected with hepatitis C virus (HCV), and chronic kidney disease (CKD) is a known consequence of HIV, HCV, and antiviral therapy. HIV-HCV co-infection also has been associated with an increased incidence and progression of CKD. This study examined the prevalence of CKD and HIV-HCV co-infection, and their influence on mortality among a national cohort of 23,155 HIV-infected Veterans who received VA care from 1998 to 2004. Using data from the Veterans Aging Cohort Study (VACS), investigators examined demographics, medical comorbidities, and use of antiretroviral therapy.

Overall, 40% of the entire cohort was co-infected with HCV, and CKD affected more than one in eight Veterans with HIV. In addition, findings show that compared with their mono-infected counterparts, Veterans with HIV who were co-infected with HCV had significantly higher rates of CKD (14% vs. 11%) and mortality. HCV co-infection independently increased the likelihood of death by nearly 25%, after adjusting for other important HIV- and HCV-related factors. Co-infected Veterans also were less likely to have received highly active antiretroviral therapy (HAART) at baseline. Authors suggest that efforts should be targeted toward optimizing medical care for mono- and co-infected Veterans, including HAART therapy, HCV antiviral therapy, and treatment of comorbid medical conditions.

Fischer M, Wyatt C, Gordon K, et al for the VACS Project Team. Hepatitis C and the Risk of Kidney Disease and Mortality in Veterans with HIV. Journal of Acquired Immune Deficiency Syndrome February 1, 2010;53(2):222-226.

Dr. Fischer is part of HSR&D's Center for the Management of Complex Chronic Care and is supported by an HSR&D Career Development Award.