While the rate of AIDS-related death has declined, as a consequence of the effectiveness of antiviral treatment for HIV, HIV/HCV coinfection and in particular liver-related death (LRD) has assumed increasing importance. This thesis aims to analyse important epidemiological areas of HIV/HCV coinfection to improve the knowledge base of the subject and provide guidance to clinicians in a fast moving area of research. Data for this thesis are from the EuroSIDA study, which is a large multi-centre pan-European prospective observational cohort study with over 18,000 HIV-positive individuals including approaching 5,000 HIV/HCV coinfected individuals. The study was initiated in 1994 and continues to expand and diversify to meet current research needs. Results from the studies included in this thesis have shown that treatment for HIV in coinfected individuals can also have a beneficial effect on the natural course of HCV, with HCV viral load remaining stable over time in those treated for HIV compared with increasing HCV viral load in those not yet treated. The incidence of treatment for HCV has steadily increased in Europe to 4.7 per 100 PYFU in 2010, but remains low with just 25% of eligible patients receiving treatment. LRD accounts for more than a fifth of deaths in this population, with significant liver fibrosis and those triple infected with HBV at increased risk. The 5-year probability of LRD is low for those with F0/F1 fibrosis (2.2%), but increases substantially for those with F2/F3 (10.3%) and F4 (14.0%) fibrosis. With potent new treatments for HCV coming to market, it is clear that while they remain prohibitively expensive they should be targeted at those at the greatest risk of LRD. The prognostic LRD score derived here will help clinicians to make difficult decisions on who should be prioritised for HCV treatment.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:674675 |
| Date | January 2015 |
| Creators | Grint, D. |
| Publisher | University College London (University of London) |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://discovery.ucl.ac.uk/1470765/ |
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