Low CD4 Cell Count Is Associated With Post–Hepatitis C Virus Cure Mortality in People With HIV (ANRS CO13 HEPAVIH Cohort)

This is the authors' abstract. We don't add key points for this paper.

To the Editor—We read with great interest the recent article from Martín-Carmona et al, who found that human immunodeficiency virus (HIV) does not increase mortality risk after hepatitis C virus (HCV) cure from direct-acting antivirals (DAAs) in people with advanced liver fibrosis [1]. By publishing long-term follow-up data, the authors provide valuable insights into the unresolved question of whether or not HIV increases the risk of mortality after HCV cure. We would like to bring further elements to address this issue by studying the impact of HIV clinical markers (plasma HIV RNA and CD4 cell count) on mortality risk in adults coinfected with HIV and HCV who participated in the French national prospective cohort ANRS CO13 HEPAVIH [2]. From this prospective cohort, we selected HCV-cured participants with available sociobehavioral data before or after DAA treatment, who had a fibrose-4 index (FIB-4) assessment at the time of HCV cure (defined as a sustained virologic response 24 weeks after completing DAA treatment), and who had completed at least 1 clinical follow-up visit after HCV cure. We computed a Cox proportional hazards model with the time of HCV cure as the entry date and all-cause mortality as the outcome, adjusted for age, sex, history of drug injection, and advanced liver fibrosis (FIB-4 score >3.25 [3]), all assessed at the time of HCV cure, as well as HIV RNA load (detectable or not, according to the laboratory test threshold) and CD4 count (<500 or ≥500 cells/mL), both used as time-dependent variables.