Chrono-optimal treatments for human immunodeficiency virus/hepatitis C virus co-infection yield comparable survival outcomes with hepatitis C virus mono-infection

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BACKGROUND Over recent decades, treatment for human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection has significantly advanced. HIV is known to accelerate liver disease progression and increase liver-related mortality in patients with HCV infection. AIM To reassess the effectiveness of HCV treatments by comparing outcomes between HIV/HCV co-infected and HCV mono-infected patients. METHODS We retrospectively included patients with HCV mono-infection or HIV/HCV co-infection at 12 tertiary referral centers from January 2009 to December 2020. The primary endpoint was overall survival (OS). Secondary endpoints included achievement of a sustained virologic response (SVR), time-to-occurrence of hepatocellular carcinoma (HCC), and the changes in fibrosis-4 (FIB-4) index. RESULTS A total of 904 patients were included: 792 with HCV mono-infection and 112 with HIV/HCV co-infection, of whom 97 (86.6%) had received prior HIV treatment. HCV treatment was administered to 741 (93.6%) mono-infected and 86 (76.8%) co-infected patients. Among treated patients, SVR was achieved in 93.4% of mono-infected and 81.4% of the co-infected group [P = 0.114 after inverse probability of treatment weighting (IPTW) adjustment]. OS and HCC occurrence showed no significant differences between groups, regardless of the HCV treatment method, after IPTW [hazard ratio (HR) = 0.37, 95% confidence interval (95%CI): 0.05-3.07, P = 0.360 for OS; HR = 0.19, 95%CI: 0.02-1.48, P = 0.113 for HCC occurrence]. The FIB-4 index significantly improved 1 year after achieving SVR with direct-acting antivirals in both groups. CONCLUSION With optimal HIV/HCV treatment regimens, HCC occurrence and mortality risks in co-infected patients have become comparable to those in patients with HCV mono-infection.