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Impact of antiretroviral therapy on liver disease progression and mortality in patients co-infected with HIV and hepatitis C: Systematic review and meta-analysis

What do we want to know?

Highly active antiretroviral therapy (HAART) is the current standard treatment for individuals co-infected with HIV and hepatitis C. The impact of HAART and antiretroviral (ARV) monotherapy on liver disease in this population is unclear. This systematic review aimed to evaluate the effect of HAART and ARV monotherapy on liver disease progression and liver-related mortality in individuals co-infected with HIV and hepatitis C, including in patients with haemophilia.

What did we find?

Thirteen cohort studies were included. In analyses that adjusted for potential confounding factors (such as age, sex and liver disease severity), the risk of liver-related mortality was reduced by around approximately 70% in patients receiving HAART when compared to untreated patients. The results were similar in unadjusted analyses. A subgroup analysis, in which most patients had haemophilia, also found that HAART was associated with a reduction in liver-related mortality.

For other outcomes where meta-analyses could not be performed, the results were less consistent. Some studies suggested a benefit of HAART in reducing the incidence or slowing the progression of liver disease, fibrosis and cirrhosis, while others showed no evidence of benefit or harm, compared with no antiretroviral therapy.

What are the conclusions?

The use of HAART was associated with significantly reduced liver-related mortality in patients co-infected with HIV and HCV. Evidence of an association between HAART and/or ARV monotherapy use and reduced liver-disease progression was less clear, but there was no evidence to suggest that the absence of antiretroviral therapy was preferable. Further research is required on the differential effects of HAART regimens, and on the mechanisms by which HAART reduces liver-disease mortality.

How did we get these results?

MEDLINE and EMBASE bibliographic databases were searched up to June 2014 for comparative studies. A systematic review on the association between HAART and/or ARV monotherapy and liver disease progression and liver-related mortality was conducted. Study quality was assessed using a modified version of the Newcastle-Ottawa scale and the results were synthesised narratively and by meta-analysis.

This report should be cited as:

Llewellyn A, Simmonds M, Brunton G, Sowden A (2015) Impact of antiretroviral therapy on liver disease progression and mortality in patients co-infected with HIV and hepatitis C: Systematic review and meta-analysis. EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.
ISBN: 978-1-907345-80-7

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