Impact of Hepatitis C on Survival of HIV-Infected Individuals in Shiraz; South of Iran

BACKGROUND: HIV and HCV infections are basic issues of many health systems. Since HIV and HCV are transmitted similarly, it is common to become infected by them simultaneously. No consensus exists on the effect of HCV infection on the survival of HIV-infected patients. OBJECTIVES: This study aimed to investigate the issue in a relatively large cohort of patients who had a high prevalence of this coinfection in Shiraz (South of Iran). PATIENTS AND METHODS: In this historical cohort study, we evaluated the survival time of 1338 HIV-infected individuals who had been referred to a behavioral consultation center in Shiraz over 10 years (from April 2001 to July 2011). Kaplan-Meier method and log-rank test were used to investigate patient survival and compare their survival curves, respectively. Moreover, Cox proportional hazards model was used to examine the effect of HCV infection on patient survival after control for age, sex, having the injection drug use (IDU) risk factor, CD4 count at baseline, more than a 30% decline in CD4 cell count, and highly active antiretroviral therapy (HAART). RESULTS: In our cohort, 1044 patients (78.03%) were infected by HCV. The median follow-up was 43.48 months (95% CI = 61.18-26.63). The median survival time in HCV-infected and uninfected patients was 163.8 and 194.8 months, respectively (P = 0.039). After controlling for other covariates, HCV infection increased the mortality rate 2.13 times more in HCV-infected patients than HCV -uninfected patients (CI: 95%; 1.1-4.52). CONCLUSIONS: HCV infection increases AIDS-related deaths. To control HCV infection and transmission and eliminate HCV, timely diagnosis and treatment and serious harm reduction programs must be implemented.