Hyaluronic Acid Levels Predict Increased Risk of Non-Aids Death in Hepatitis-Coinfected Persons Interrupting Antiretroviral Therapy in the Smart Study

Abstract

Background: In the SMART study, HIV–viral-hepatitis-coinfected persons were, compared with HIV-monoinfected persons, at higher risk of non-AIDS death if randomized to the antiretroviral therapy (ART) interruption strategy. We hypothesized that a marker of liver fibrosis, hyaluronic acid (HA), would be predictive of development of non-AIDS-related outcomes in coinfected participants in the SMART study. Methods: All participants positive for HCV RNA or hepatitis B surface antigen (HBsAg) and with stored plasma samples were included ( n=675). Plasma samples were tested for HA (normal range 0–75 ng/ml) at baseline and months 6, 12 and 24 during follow-up in the drug conservation (DC; interrupt ART until CD4⁺ T-cell count 75 ng/ml had a cumulative risk of non-AIDS death of 24.6% after 36 months of follow-up compared with 9.3% for participants randomized to the VS group ( P=0.005), while the cumulative risk for coinfected participants with HA≤75 ng/ml was 4.1% (DC) and 4.7% (VS; P=0.76). The change in HA from baseline to month 24 was 8.3 ng/ml and 4.7 ng/ml in the DC and VS group ( P=0.56), respectively. Conclusions: Interruption of ART was particularly unsafe in HIV–hepatitis-coinfected individuals if plasma HA was increased. HA changed very little during follow-up and was not influenced by differences in CD4⁺ T-cell count or HIV viral load.