Antiretroviral therapy and liver disease progression in HIV and hepatitis C co-infected patients: a systematic review and meta-analysis

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Background: HIV co-infection exacerbates hepatitis C disease, increasing the risk of cirrhosis and hepatitis C-related
mortality. Combination antiretroviral therapy (cART) is the current standard treatment for co-infected individuals, but
the impact of cART and antiretroviral (ARV) monotherapy on liver disease in this population is unclear. We aimed to
assess the effect of cART and ARV monotherapy on liver disease progression and liver-related mortality in
individuals co-infected with HIV and chronic hepatitis C.
Methods: A systematic review with meta-analyses was conducted. MEDLINE and EMBASE bibliographic databases
were searched up to September 2015. Study quality was assessed using a modified Newcastle-Ottawa scale. Results
were synthesised narratively and by meta-analysis.
Results: Fourteen observational studies were included. In analyses that adjusted for potential confounders, risk of
liver-related mortality was significantly lower in patients receiving cART (hazard ratio/odds ratio 0.31, 95 % CI 0.14 to
0.70). Results were similar in unadjusted analyses (relative risk 0.40, 95 % CI 0.29 to 0.55). For outcomes where metaanalysis
could not be performed, results were less consistent. Some studies found cART was associated with lower
incidence of, or slower progression of liver disease, fibrosis and cirrhosis, while others showed no evidence of benefit.
We found no evidence of liver-related harm from cART or ARV monotherapy compared with no HIV therapy.
Conclusions: cART was associated with significantly lower liver-related mortality in patients co-infected with HIV and
HCV. Evidence of a positive association between cART and/or ARV monotherapy and liver-disease progression was less
clear, but there was no evidence to suggest that the absence of antiretroviral therapy was preferable.
Keywords: Systematic review, Meta-analysis, Anti-retroviral agents, Hepatitis C, HIV
Original languageEnglish
Number of pages11
JournalHepatology, Medicine and Policy
Issue number10
Publication statusPublished - 15 Aug 2016

Bibliographical note

© 2016, The Author(s).


  • Systematic review, Meta-analysis, Anti-retroviral agents, Hepatitis C, HIV

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