Mortality in HIV‐infected injection drug users with active vs cleared hepatitis C virus‐infection: a population‐based cohort study

Summary. Acute hepatitis C virus (HCV) infection may lead to chronic HCV‐infection with detectable HCV RNA or to spontaneous clearance with no HCV RNA, but detectable HCV antibodies. It is unknown whether HCV RNA status is associated with mortality in HIV‐infected injection drug users (IDUs). We conducted a nationwide population‐based cohort study to examine the impact of HCV RNA status on overall and cause‐specific mortality in HIV‐infected IDUs. We computed cumulative mortality and used Cox Regression to estimate mortality rate ratios (MRR). We identified 392 HIV‐infected patients of whom 284 (72%) had chronic HCV‐infection (HCV RNA positive patients) and 108 (28%) had cleared the HCV‐infection (HCV RNA negative patients). During 1286 person‐years of observation (PYR), 157 persons died (MR = 122/1000 PYR, 95% CI: 104–143). The estimated 5‐year probabilities of survival were 0.58 (95% CI: 0.51–0.65) in the chronically HCV‐infected and 0.52 (95% CI: 0.40–0.63) in the cleared HCV group. Chronic HCV‐infection was not associated with overall mortality: MRR 0.85, 95% CI: 0.59–1.21. In HIV‐infected Danish IDUs, chronic HCV‐infection is not associated with increased mortality compared to patients who have cleared the infection.