Impact of behavioural factors on health and survival of HIV-HCV patients

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Novel five-year study highlights importance of behaviours such as coffee drinking and not smoking on health and survival of HIV and HCV infected patients, report investigators. Patients infected by both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are at specific risk of end-stage liver disease and greater risk of cardiovascular diseases and cancer. In addition, HIV infection accelerates the progression of chronic hepatitis C to fibrosis and development of cirrhosis and end-stage liver disease. In these HIV-HCV co-infected patients, drinking at least three cups of coffee each day halved the risk of all-cause mortality according to a study.

This study is the first to investigate the relationship between coffee consumption and the risk of all-cause mortality in HIV-HCV co-infected patients. “This is a very exciting time for HCV research as a cure that can eradicate the virus is now available for all patients,” explained lead investigator Dr Dominique Salmon-Céron, of the Service des Maladies Infectieuses et Tropicales, Hôpital Cochin, and Université Paris Descartes, Paris, France. “However, even when cured of HCV, patients co-infected with HIV have a higher risk of death with respect to the general population, due to an accelerated aging process that may result from cancer, complications related to diabetes and to liver disease, and from cardiovascular events.”

Coffee is known to have anti-inflammatory and liver-protective properties. In the general population, drinking three or more cups of coffee a day has been found to be associated with a 14% reduction in the risk of all-cause mortality. This is probably due to the properties of polyphenols contained in coffee that can protect the liver and also reduce inflammation.

Investigators used data from a five-year follow-up of 1,028 HIV-HCV co-infected patients enrolled in the French national ANRS CO13-HEPAVIH cohort. ANRS CO13-HEPAVIH is an ongoing French nationwide prospective cohort of HIV-HCV co-infected patients that collects both medical and psycho-social/behavioural data over time via annual self-administered questionnaires.

At enrolment, one in four patients reported drinking at least three cups of coffee daily. Over the five years, 77 deaths occurred, almost half attributable to hepatitis C. However, the mortality risk was 80% lower in those who were cured of (who “cleared”) hepatitis C thanks to treatment.

Further analysis showed that drinking at least three cups of coffee daily was associated with a 50% reduction in mortality risk even after taking into account HCV clearance, HIV- and HCV-related factors, and other socio-behavioural factors, such as having a steady partner and not smoking. Healthy behaviour change should be promoted by physicians following HCV clearance.

This research highlights the importance of behaviours – coffee consumption and not smoking in particular – on reduced mortality risk. These results can help promote behavioral changes in HIV-HCV patients, which in turn can result in improved survival. With respect to coffee consumption, individuals who do not drink coffee because of caffeine can still benefit from the comparable anti-inflammatory effects of decaffeinated coffee.

First author Dr Maria Patrizia Carrieri, of the HEPAVIH Study Group, Faculté de Médecine, Aix Marseille University, INSERM, IRD, SESSTIM, Marseilles, France, observed that coffee consumption provides more protective effects on mortality in the HIV-HCV population than in the general population.

“The results of our study show that while curing HCV is fundamental, it must be complemented by behavioral changes if we are to improve health and survival in HIV-infected patients whether or not they cleared HCV. “I think we need to better monitor coffee consumption, together with other behaviors, such as alcohol use, smoking, physical activity, and to propose interventions to our patients which facilitate healthy behaviors even after HCV clearance. We also suggest that those patients who cannot tolerate a high intake of caffeine should consider drinking a few cups of decaffeinated coffee a day,” commented Salmon-Céron. “Accordingly, I believe that the benefits of coffee extracts and supplementing dietary intake with other anti-inflammatory compounds need to be evaluated in HIV-HCV patients.”

Abstract
Background & Aims: Coffee has anti-inflammatory and hepato-protective properties. In the general population, drinking ≥3 cups of coffee/day has been associated with a 14% reduction in the risk of all-cause mortality. The aim of this study was to investigate the relationship between coffee consumption and the risk of all-cause mortality in patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV).
Methods: ANRS CO13 HEPAVIH is an ongoing French nationwide prospective cohort of patients co-infected with HIV-HCV collecting both medical and psychosocial/behavioural data (annual self-administered questionnaires). We used a Cox proportional hazards model to estimate the effect of elevated coffee consumption (≥3 cups/day) at baseline on all-cause mortality during the cohort’s five-year follow-up.
Results: Over a median [interquartile range] follow-up of 5.0 [3.9–5.9] years, 77 deaths occurred among 1,028 eligible patients (mortality rate 1.64/100 person-years; 95% confidence interval [CI] 1.31–2.05). Leading causes of death were HCV-related diseases (n = 33, 43%), cancers unrelated to AIDS/HCV (n = 9, 12%), and AIDS (n = 8, 10%). At the first available visit, 26.6% of patients reported elevated coffee consumption. Elevated coffee consumption at baseline was associated with a 50% reduced risk of all-cause mortality (hazard ratio 0.5; CI 0.3–0.9; p = 0.032), after adjustment for gender and psychosocial, behavioral and clinical time-varying factors.
Conclusions: Drinking three or more cups of coffee per day halves all-cause mortality risk in patients co-infected with HIV-HCV. The benefits of coffee extracts and supplementing dietary intake with other anti-inflammatory compounds need to be evaluated in this population.

Authors
Maria Patrizia Carrieri, Camelia Protopopescu, Fabienne Marcellin, Silvia Rosellini, Linda Wittkop, Laure Esterle, David Zucman, François Raffi, Eric Rosenthal, Isabelle Poizot-Martin, Dominique Salmon-Ceron, François Dabis, Bruno Spire

Elsevier material
Journal of Hepatology abstract


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