Impact of diabetes on the risk of serious liver events and liver-related deaths in people living with HIV and hepatitis C co-infection: data from the ICONA Foundation Cohort Study

• Published in: European journal of clinical microbiology & infectious diseases 2019-10, Vol.38 (10), p.1857-1865
• Main Authors: Leone, Sebastiano, Lorenzini, Patrizia, Cozzi-Lepri, Alessandro, Orofino, Giancarlo, Bernacchia, Dario, Castagna, Antonella, Menozzi, Marianna, Guaraldi, Giovanni, Madeddu, Giordano, Di Biagio, Antonio, Puoti, Massimo, Gori, Andrea, d’Arminio Monforte, Antonella
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomedical and Life Sciences; Biomedicine; Cohort analysis; Coinfection - complications; Diabetes; Diabetes Complications - epidemiology; Diabetes mellitus; Diagnosis; Fatalities; Female; Fibrosis; Health risks; Hepatitis C; Hepatitis C, Chronic - complications; HIV; HIV Infections - complications; Human immunodeficiency virus; Humans; Incidence; Infections; Internal Medicine; Liver; Liver Cirrhosis - epidemiology; Liver Cirrhosis - mortality; Liver Failure - epidemiology; Liver Failure - mortality; Male; Medical Microbiology; Middle Aged; Original Article; Population; Prospective Studies; Risk; Risk Assessment; Survival Analysis
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-019-03618-8

To investigate the association between diabetes and HCV infection in persons living with HIV and to determine the impact of diabetes on the occurrence of serious liver events (SLEs) and liver-related deaths (LRDs) among HIV/HCV-co-infected patients. Patients were included if they had at least one follow-up visit. In a cross-sectional analysis among all HIV patients, we have investigated the association between diabetes and HCV infection. A further longitudinal analysis was performed in the population of HIV/HCV-co-infected free from SLE with FIB-4 index  3.25; (C) first event between SLE, LRD, and liver fibrosis progression. Data from 15,571 HIV patients were analyzed: 2944 (18.9%) were HCV-Ab positive, and 739 (4.7%) presented a diagnosis of diabetes at their last follow-up. Among HIV/HCV-co-infected population, 107 patients had a diagnosis of diabetes. Viremic HCV-co-infected patients had 3-fold risk of diabetes onset than HCV-uninfected patients. On HIV/HCV-co-infected population, 85 SLEs/LRDs occurred over 20,410 person-years of follow-up (PYFU), for an incidence rate of 4.2/1000 PYFU (95%CI 3.4–5.2). Diabetic patients had 3-fold risk of pooled SLE and LRD than patients without diabetes. Furthermore, viremic HCV infection was independently associated with a higher risk of SLE/LRD (aIRR 3.35 [95%CI 1.14–9.83]). In HIV-infected patients, viremic HCV co-infection is a strong predictor of diabetes. Among HIV/HCV-co-infected population, diabetic patients showed an increased risk of SLE/LRD compared with those without diabetes.