Risks of Non-Accidental Mortality by Baseline CD4+ T-Cell Strata in Hepatitis-C-Positive and -Negative Individuals Initiating Highly Active Antiretroviral Therapy

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Abstract
Background: Patients coinfected with hepatitis C virus (HCV) and HIV experience higher mortality rates than patients infected with HIV alone. We designed a study to determine whether risks for later mortality are similar for HCV-positive and HCV-negative individuals when subjects are stratified on the basis of baseline CD4+ T-cell counts. Methods: Antiretroviral-naive individuals, who initiated highly active antiretroviral therapy (HAART) between 1996 and 2002 were included in the study. HCV-positive and HCV-negative individuals were stratified separately by baseline CD4+ T-cell counts of 50 cell/μl increments. Cox-proportional hazards regression was used to model the effect of these strata with other variables on survival. Results: CD4+ T-cell strata below 200 cells/μl, but not above, imparted an increased relative hazard (RH) of mortality for both HCV-positive and HCV-negative individuals. Among HCV-positive individuals, after adjustment for baseline age, HIV RNA levels, history of injection drug use and adherence to therapy, only CD4+ T-cell strata of 500 cells/μl. The same baseline CD4+ T-cell strata were found for HCV-negative individuals. Conclusion: In a within-groups analysis, the baseline CD4+ T-cell strata that are associated with increased RHs for mortality are the same for HCV-positive and HCV-negative individuals initiating HAART. However, a between-groups analysis reveals a higher absolute mortality risk for HCV-positive individuals.