Whites fare poorly with HIV and hepatitis C

Liver disease and death rates are worse with hepatitis C virus (HCV) infection on top of HIV infection than with just HIV or HCV, especially among white patients, according to a new report.

"We need to better understand why the co-infected patients do so poorly and the underlying mechanism for apparent racial disparity in their outcome," Dr. Kyong-Mi Chang, told Reuters Health.

"We also need better drugs that directly target HCV," added Chang, from the University of Pennsylvania and Philadelphia Veterans Affairs Medical Center.

Chang's team examined the impact of dual infection and race in 265 veterans with HCV/HIV co-infection, 251 infected with HCV only, and 227 others with HIV only.

Over a three-year period, mortality was significantly greater among HCV/HIV-co-infected patients than among patients mono-infected with either HCV or HIV, the researchers report in the American Journal of Gastroenterology.

Specifically, after taking into account a variety of factors, mono-infected patients were only about one-third as likely to die as dual-infected patients.

During the study period, twice as many white patients died compared to black patients, the report indicates.

Also, the average age at death in white patients (46 years) was significantly younger than that in black patients (52 years).

Since dual-infected patients fare so poorly, Chang said, the team aims to treat them "as much as possible and monitor them closely for liver dysfunction." He said specialists in liver disease and infectious diseases "as well as pharmacists (also social work and mental health support), is needed to optimize therapy for these complex patients."

SOURCE: American Journal of Gastroenterology, April 2006.